Provider Demographics
NPI:1992479562
Name:LUKENS, JORDAN C (DC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:C
Last Name:LUKENS
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 1:1207 CREWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7582
Mailing Address - Country:US
Mailing Address - Phone:704-246-6111
Mailing Address - Fax:
Practice Address - Street 1:1207 CREWS RD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7582
Practice Address - Country:US
Practice Address - Phone:704-246-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty