Individual provider Active NPI

Mark Douglas Luell Sr., D.C.

  • Chiropractor
  • Stone MTN, GA
National Provider Identifier
1811037864
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
001417 Issued in GA
Practice address
1344 Rockbridge Rd
Stone MTN, GA 30087-3138
Phone
(770) 923-8787
NPI assigned
Feb 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 001417 GA Primary

Addresses

Primary practice location

1344 Rockbridge Rd
Stone MTN, GA 30087-3138

Mailing address

5150 Island Dr
Stone MTN, GA 30087-4248
Phone (770) 469-2210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
001417GAMDChiropractor
1126GAMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811037864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 ISLAND DR",
            "city": "STONE MTN",
            "state": "GA",
            "postal_code": "300874248",
            "telephone_number": "770-469-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 ROCKBRIDGE RD",
            "city": "STONE MTN",
            "state": "GA",
            "postal_code": "300873138",
            "telephone_number": "770-923-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUELL",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "001417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone MTN, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.