Provider Demographics
NPI:1174549414
Name:LUKE, EDDY D (DC)
Entity type:Individual
Prefix:DR
First Name:EDDY
Middle Name:D
Last Name:LUKE
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:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16603-1104
Mailing Address - Country:US
Mailing Address - Phone:814-943-4116
Mailing Address - Fax:
Practice Address - Street 1:1915 VALLEY VIEW BLVD REAR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6527
Practice Address - Country:US
Practice Address - Phone:814-941-1400
Practice Address - Fax:814-941-0862
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALU1840594OtherBS INDIV PROV NUMBER
PA1575599OtherHIGHMARK BC/BS GROUP NUMB