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NPI Code Detail

MEDICARE: DR. GREGORY CHARLES LUCAS D.C.

MEDICARE: DR. GREGORY CHARLES LUCAS D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor1513OH
2111N00000XChiropractor1134SC
3111N00000XChiropractor4296AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000136021OTHEROHANTHEM INSURANCE

General Provider Information

NPI Number : 1770589566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY CHARLES LUCAS D.C.
Provider Business Mailing Address
First Line : 168 EAST AVE
Second Line :
City : TALLMADGE
State : OH
Zip : 44278-2311
Country : US
Telephone Number : 330-633-1909
Fax Number :
Provider Business Practice Location Address
First Line : 168 EAST AVE
Second Line :
City : TALLMADGE
State : OH
Zip : 44278-2311
Country : US
Telephone Number : 330-633-1909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2005
Last Update Date : 03/25/2013

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