Provider Demographics
NPI:1467689133
Name:LUDWIG, JACOB WILLIAM (DC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:WILLIAM
Last Name:LUDWIG
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 1:325 N NASH ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELDER
Mailing Address - State:KS
Mailing Address - Zip Code:67446-9404
Mailing Address - Country:US
Mailing Address - Phone:785-738-7704
Mailing Address - Fax:
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-2402
Practice Address - Country:US
Practice Address - Phone:785-738-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor