Provider Demographics
NPI:1699093989
Name:LUCE CHIROPRACTIC
Entity type:Organization
Organization Name:LUCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-254-1811
Mailing Address - Street 1:3630 W SOUTH JORDAN PKWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7153
Mailing Address - Country:US
Mailing Address - Phone:801-254-1811
Mailing Address - Fax:
Practice Address - Street 1:3630 W SOUTH JORDAN PKWY
Practice Address - Street 2:STE. 102
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7153
Practice Address - Country:US
Practice Address - Phone:801-254-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT71998841202OtherUTAH STATE CHIROPRACTIC LICENSE NUMBER