MEDICARE: MR. JACOB WILLIAM LUDWIG 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	01-05273	KS

General Provider Information

NPI Number	:	1467689133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB WILLIAM LUDWIG D.C.

Provider Business Mailing Address
First Line	:	325 N NASH ST
Second Line	:
City	:	GLEN ELDER
State	:	KS
Zip	:	67446-9404
Country	:	US
Telephone Number	:	785-738-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W MAIN ST
Second Line	:
City	:	OSBORNE
State	:	KS
Zip	:	67473-2402
Country	:	US
Telephone Number	:	785-738-7704
Fax Number	:

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

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	03/01/2012

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