Provider Demographics
NPI:1730201435
Name:LUKOVSKY, LORI DARLENE (DC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DARLENE
Last Name:LUKOVSKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DARLENE
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3550 LEXINGTON AVE N
Mailing Address - Street 2:STE 210
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8092
Mailing Address - Country:US
Mailing Address - Phone:651-486-3811
Mailing Address - Fax:
Practice Address - Street 1:1050 COUNTY ROAD E. WEST
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8022
Practice Address - Country:US
Practice Address - Phone:651-484-8448
Practice Address - Fax:651-484-2066
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN82D42LUOtherBCBS
MN350002149Medicare PIN
U81070Medicare UPIN