Provider Demographics
NPI:1306834205
Name:LUDE, LANNY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:DAVID
Last Name:LUDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4118
Mailing Address - Country:US
Mailing Address - Phone:910-392-1041
Mailing Address - Fax:877-221-1965
Practice Address - Street 1:3418 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4118
Practice Address - Country:US
Practice Address - Phone:910-392-1041
Practice Address - Fax:877-221-1965
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0823PMedicaid
NC89-0823PMedicaid
NC2451424Medicare ID - Type Unspecified