Provider Demographics
NPI:1962553131
Name:LUCAS CHIRO CLINIC INC
Entity type:Organization
Organization Name:LUCAS CHIRO CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-357-6100
Mailing Address - Street 1:1261 S SEWARD MERIDIAN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8334
Mailing Address - Country:US
Mailing Address - Phone:907-357-6101
Mailing Address - Fax:907-357-6102
Practice Address - Street 1:1261 S SEWARD MERIDIAN RD
Practice Address - Street 2:SUITE F
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8334
Practice Address - Country:US
Practice Address - Phone:907-357-6101
Practice Address - Fax:907-357-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK89111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0054Medicaid
AKCH0217Medicaid
AKCHG031Medicaid
AKT67048Medicare UPIN
AKK153105Medicare UPIN