Provider Demographics
NPI:1811964638
Name:LUXEDER, MARYANN E (DC OF CHIROPRACTIC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:E
Last Name:LUXEDER
Suffix:
Gender:F
Credentials:DC OF CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-2730
Mailing Address - Country:US
Mailing Address - Phone:910-285-7222
Mailing Address - Fax:910-285-7229
Practice Address - Street 1:116 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-2730
Practice Address - Country:US
Practice Address - Phone:910-285-7222
Practice Address - Fax:910-285-7229
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHIGHMARKOtherPA BLUES
PAHIGHMARKOtherPA BLUES
PAV07626Medicare UPIN