Healthcare Provider Details

I. General information

NPI: 1811964638
Provider Name (Legal Business Name): MARYANN E. LUXEDER DC OF CHIROPRACTIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N NORWOOD ST
WALLACE NC
28466-2730
US

IV. Provider business mailing address

116 N NORWOOD ST
WALLACE NC
28466-2730
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-7222
  • Fax: 910-285-7229
Mailing address:
  • Phone: 910-285-7222
  • Fax: 910-285-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: