Provider Demographics
NPI:1487666426
Name:LUSCOMB, JONATHAN P (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:LUSCOMB
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 1:76 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4239
Mailing Address - Country:US
Mailing Address - Phone:978-521-5000
Mailing Address - Fax:978-521-2659
Practice Address - Street 1:100 MILK STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4600
Practice Address - Country:US
Practice Address - Phone:978-984-6636
Practice Address - Fax:978-984-6486
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH270-0687B111N00000X
MA718111N00000X
MACHI718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0508330YOMA01OtherANTHEM BCBS
MA351388OtherHARVARD PILGRIM
MA1613294Medicaid
MAY35497OtherBLUECROSSBLUESHIELD PROVI
MAY39435OtherBLUECROSSBS GROUP ID
MA731869OtherTUFTS
MA1613294Medicaid