Individual provider Active NPI

Lawrence J Ludtke, D.C.

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1316001308
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR007872 Issued in GA
Practice address
1459 Cobb Pkwy N
Marietta, GA 30062-2425
Phone
(770) 919-9625
Fax
(770) 919-8154
NPI assigned
Dec 21, 2006
Last updated
Sep 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR007872 GA Primary

Addresses

Primary practice location

1459 Cobb Pkwy N
Marietta, GA 30062-2425

Mailing address

1459 Cobb Pkwy N
Marietta, GA 30062-2425
Phone (770) 919-9625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150925000265 GA Practitioner - Chiropractic 8628147329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiropractic Total Health Center, LLCGroup PAC ID 2163579103, 2 clinicians

Practice addresses (Care Compare)

1459 Cobb Pkwy N
Marietta, GA 30062-2425

1459 Cobb Pkwy NW
Marietta, GA 30062-2425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR007872GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Total Health Center, LLC Chiropractor CurrentSince Jan 1, 2009 Accepting new patients
Kennesaw Health and Wellness Chiropractor Past Accepting new patients

Locations

1459 Cobb Pkwy N
Marietta, GA 30062
Phone (770) 919-9625

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1316001308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 COBB PKWY N",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622425",
            "telephone_number": "770-919-9625",
            "fax_number": "770-919-8154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 COBB PKWY N",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622425",
            "telephone_number": "770-919-9625",
            "fax_number": "770-919-8154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUDTKE",
        "first_name": "LAWRENCE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.