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General NPI Number Information
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NPI Number | 1356894117
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Entity Type | Individual
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Provider Name | LOGAN WRENN LUZADDER DC, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1479 ROUTE 539
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City | LITTLE EGG HARBOR TWP
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State | NJ
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Zip | 08087-9609
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Country | US
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Telephone | 609-829-5656
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Fax | 609-257-0002
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Provider Business Mailing Address
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Address Line | 1479 ROUTE 539 UNIT 2A
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City | LITTLE EGG HARBOR TWP
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State | NJ
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Zip | 08087-9609
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Country | US
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Telephone | 609-829-5656
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Fax | 609-257-0002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 0104-557362
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License Number State | VA
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