MEDICARE: DR. LUCAS J MATLOCK 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
1	111N00000X	Chiropractor	2150	CT

General Provider Information

NPI Number	:	1982882361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCAS J MATLOCK D.C

Provider Business Mailing Address
First Line	:	642 HILLIARD ST STE 1218
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2702
Country	:	US
Telephone Number	:	678-794-9334
Fax Number	:

Provider Business Practice Location Address
First Line	:	642 HILLIARD ST STE 1218
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2702
Country	:	US
Telephone Number	:	678-794-9334
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	01/14/2026

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