MEDICARE: SETH B. LUEDERS D.C.

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	19198	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	943239914	OTHER	CA	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1437220175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH B. LUEDERS D.C.

Provider Business Mailing Address
First Line	:	6105 SNELL AVE
Second Line	:	SUITE 101
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4739
Country	:	US
Telephone Number	:	408-578-1460
Fax Number	:	408-578-1804

Provider Business Practice Location Address
First Line	:	6105 SNELL AVE
Second Line	:	SUITE 101
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4739
Country	:	US
Telephone Number	:	408-578-1460
Fax Number	:	408-578-1804

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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