Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2611 | OH |
NPI | 1033223284 |
---|---|
Provider Name | Dr. Lucas Joseph Smith |
First Address | Upper Sandusky, OH 43351-9201 |
Second Address | Upper Sandusky, OH 43351-9201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 11/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000115406 | BLUE CROSS (01) | OH |
1033223284 | NPI (01) | OH |
2795097 | (05) | OH |
5871514 | AETNA (01) | OH |
U68335 | (02) | OH |