Provider Demographics
NPI:1902354962
Name:WAACK, LUKE (DC)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:WAACK
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 1:21800 COHOE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610-9333
Mailing Address - Country:US
Mailing Address - Phone:907-707-5341
Mailing Address - Fax:907-802-2674
Practice Address - Street 1:198 W MARYDALE AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7501
Practice Address - Country:US
Practice Address - Phone:907-707-5341
Practice Address - Fax:907-802-2674
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor