Provider Demographics
NPI:1487374401
Name:LUKER, LEXIE (DC)
Entity type:Individual
Prefix:
First Name:LEXIE
Middle Name:
Last Name:LUKER
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 1:1428 NEWTON CIR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3879
Mailing Address - Country:US
Mailing Address - Phone:208-201-2974
Mailing Address - Fax:
Practice Address - Street 1:1515 ASHMENT AVE STE 2
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5738
Practice Address - Country:US
Practice Address - Phone:208-881-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor