Provider Demographics
NPI:1194722918
Name:LUKASIK, TIMOTHY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:LUKASIK
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 1:295 ENEZ DR
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1209
Mailing Address - Country:US
Mailing Address - Phone:716-684-5365
Mailing Address - Fax:
Practice Address - Street 1:4917 WILLIAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-3200
Practice Address - Country:US
Practice Address - Phone:716-706-0005
Practice Address - Fax:716-706-0220
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor