Provider Demographics
NPI:1154567659
Name:MCCULLY, LUCAS C (DC)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:C
Last Name:MCCULLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E TERRA COTTA AVE STE 144
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3634
Mailing Address - Country:US
Mailing Address - Phone:815-526-3658
Mailing Address - Fax:
Practice Address - Street 1:820 E TERRA COTTA AVE STE 144
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3634
Practice Address - Country:US
Practice Address - Phone:815-526-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60043071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor