Provider Demographics
NPI:1538249149
Name:LUSTER, BOBBY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JOSEPH
Last Name:LUSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:LUSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2412 US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1209
Mailing Address - Country:US
Mailing Address - Phone:334-514-7327
Mailing Address - Fax:334-514-7328
Practice Address - Street 1:2412 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1209
Practice Address - Country:US
Practice Address - Phone:334-514-7327
Practice Address - Fax:334-514-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051532805OtherBCBSAL
AL051549418OtherBCBS
AL051549418OtherBCBS