Provider Demographics
NPI:1346639663
Name:VANACKER, LUCAS TODD (DC)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:TODD
Last Name:VANACKER
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 1:24 ST LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694
Mailing Address - Country:US
Mailing Address - Phone:585-797-7869
Mailing Address - Fax:
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:STE 106
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2905
Practice Address - Country:US
Practice Address - Phone:315-705-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor