Provider Demographics
NPI:1174590525
Name:LOUCKS, LINCOLN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:DOUGLAS
Last Name:LOUCKS
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 1:16519 MEADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4834
Mailing Address - Country:US
Mailing Address - Phone:636-399-7486
Mailing Address - Fax:636-532-1983
Practice Address - Street 1:117 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-3834
Practice Address - Country:US
Practice Address - Phone:540-434-5720
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556436111N00000X
PADC009590111N00000X
MO2006005941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor