Provider Demographics
NPI:1932183555
Name:LUEDDEKE, MICHAEL B (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:LUEDDEKE
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 1:2843 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4257
Mailing Address - Country:US
Mailing Address - Phone:610-435-5000
Mailing Address - Fax:610-435-6556
Practice Address - Street 1:2843 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4257
Practice Address - Country:US
Practice Address - Phone:610-435-5000
Practice Address - Fax:610-435-6556
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007664L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU78864Medicare UPIN
PA035090Medicare ID - Type Unspecified