Provider Demographics
NPI:1902970445
Name:LUKIN, ROBERT DAVID (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:LUKIN
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 1:2020 SILVER BELL RD STE 9
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1050
Mailing Address - Country:US
Mailing Address - Phone:651-452-7018
Mailing Address - Fax:651-686-6130
Practice Address - Street 1:2020 SILVER BELL RD STE 9
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1050
Practice Address - Country:US
Practice Address - Phone:651-452-7018
Practice Address - Fax:651-686-6130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN657727000Medicaid
MN25322LUOtherBCBS GROUP NUMBER
MN230505OtherCHIROPRACTIC CARE OF MN
MN77035LUOtherBCBS INDIVIDUAL ID