Provider Demographics
NPI:1124864897
Name:LUDWIG, MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
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 1:2518 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3449
Mailing Address - Country:US
Mailing Address - Phone:712-830-0913
Mailing Address - Fax:
Practice Address - Street 1:606 CARROLL ST STE A
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:IA
Practice Address - Zip Code:51248-1177
Practice Address - Country:US
Practice Address - Phone:712-930-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor