Provider Demographics
NPI:1023337235
Name:LUCTERHAND, ANGELA G (DC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:LUCTERHAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 COUNTY ROAD 17
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9329
Mailing Address - Country:US
Mailing Address - Phone:574-522-2255
Mailing Address - Fax:
Practice Address - Street 1:663 COUNTY ROAD 17
Practice Address - Street 2:SUITE 3
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9329
Practice Address - Country:US
Practice Address - Phone:574-522-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002506A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor