Provider Demographics
NPI:1629019641
Name:LUTHER, JEANA M
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:M
Last Name:LUTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W SMITHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666
Mailing Address - Country:US
Mailing Address - Phone:724-547-3541
Mailing Address - Fax:724-547-0800
Practice Address - Street 1:615 W SMITHFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-3541
Practice Address - Fax:724-547-0800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007943L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
070086Medicare ID - Type Unspecified
U89681Medicare UPIN