MEDICARE: DR. BENJAMIN FREDRICK LUCEY DC

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
1	111N00000X	Chiropractor	2301010031	MI

General Provider Information

NPI Number	:	1942552351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN FREDRICK LUCEY DC

Provider Business Mailing Address
First Line	:	6504 28TH ST SE SUITE H
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6929
Country	:	US
Telephone Number	:	616-202-7991
Fax Number	:	616-228-8778

Provider Business Practice Location Address
First Line	:	6504 28TH ST SE
Second Line	:	SUITE H
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6959
Country	:	US
Telephone Number	:	989-390-5799
Fax Number	:	616-228-8778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	02/05/2016

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