MEDICARE: RYAN EDDY LUTZ DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3838	SC
2	111NI0900X	Internist Chiropractor	3838	SC
3	111NN1001X	Nutrition Chiropractor	3838	SC
4	111NR0400X	Rehabilitation Chiropractor	3838	SC
5	111NS0005X	Sports Physician Chiropractor	3838	SC

General Provider Information

NPI Number	:	1275974073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN EDDY LUTZ DC

Provider Business Mailing Address
First Line	:	103 SHERMAN DR
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-4879
Country	:	US
Telephone Number	:	864-420-5610
Fax Number	:	866-867-7043

Provider Business Practice Location Address
First Line	:	103 SHERMAN DR
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-4879
Country	:	US
Telephone Number	:	864-420-5610
Fax Number	:	866-867-7043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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