Healthcare Provider Details

I. General information

NPI: 1659724136
Provider Name (Legal Business Name): BRIAN LUEDKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-2119
US

IV. Provider business mailing address

1920 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-2119
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-0072
  • Fax: 480-994-8527
Mailing address:
  • Phone: 480-994-0072
  • Fax: 480-994-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8565
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: