=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174945463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CIARA ANN LUETTGEN D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 03/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 POTTSVILLE MINERSVILLE HWY
-----------------------------------------------------
City | POTTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17901-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-544-8120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 INDIANA AVE
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17976-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-590-9806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC010832
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------