MEDICARE: DR. MARK DOUGLAS LUELL SR. 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	001417	GA

General Provider Information

NPI Number	:	1811037864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DOUGLAS LUELL SR. D.C.

Provider Business Mailing Address
First Line	:	5150 ISLAND DR
Second Line	:
City	:	STONE MTN
State	:	GA
Zip	:	30087-4248
Country	:	US
Telephone Number	:	770-469-2210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 ROCKBRIDGE RD
Second Line	:
City	:	STONE MTN
State	:	GA
Zip	:	30087-3138
Country	:	US
Telephone Number	:	770-923-8787
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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