Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3838 | SC |
N | 207R00000X | Internist | 3838 | SC |
N | 111NI0900X | Internist | 3838 | SC |
N | 111NN1001X | Nutrition | 3838 | SC |
N | 111NR0400X | Rehabilitation Chiropractor | 3838 | SC |
N | 111NS0005X | Chiropractic Sports Physician | 3838 | SC |
NPI | 1275974073 |
---|---|
Provider Name | Ryan Eddy Lutz |
First Address | Boiling Springs, SC 29316-4879 |
Second Address | Boiling Springs, SC 29316-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2013 |
Last Update Date | 10/07/2013 |