Provider Demographics
NPI:1669594032
Name:LUEDEKE, THOMAS PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:LUEDEKE
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:PO BOX 33036
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-0036
Mailing Address - Country:US
Mailing Address - Phone:321-676-0020
Mailing Address - Fax:321-951-7065
Practice Address - Street 1:878 N MIRAMAR AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3054
Practice Address - Country:US
Practice Address - Phone:321-676-0020
Practice Address - Fax:321-951-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU31151Medicare UPIN