Individual provider Active NPI

Maryann E. Luxeder, DC OF CHIROPRACTIC

  • Chiropractor
  • Wallace, NC
National Provider Identifier
1811964638
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC009525 Issued in PA
Practice address
116 N Norwood St
Wallace, NC 28466-2730
Phone
(910) 285-7222
Fax
(910) 285-7229
NPI assigned
Mar 1, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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 DC009525 PA Primary

Addresses

Primary practice location

116 N Norwood St
Wallace, NC 28466-2730

Mailing address

116 N Norwood St
Wallace, NC 28466-2730
Phone (910) 285-7222

Other identifiers 1

IdentifierTypeStateIssuer
HIGHMARKOtherPAPA BLUES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070831000180 NC Practitioner - Chiropractic 5991726143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graybar-Clinton, IncGroup PAC ID 6305924572, 3 clinicians

Practice addresses (Care Compare)

600 Beaman St
Clinton, NC 28328-2604
Phone (910) 285-7222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3722NCMDBehavioral Analyst
DC009525PAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Graybar Chiropractic, Inc. Chiropractor CurrentSince May 1, 2007 Accepting new patients
Graybar-Clinton, Inc Chiropractor CurrentSince Oct 23, 2007 Accepting new patients
Proadjuster Chiropractic Clinic Chiropractor Past Accepting new patients

Locations

600 Beaman St
Clinton, NC 28328
Phone (910) 285-7222

116 N Norwood St
Wallace, NC 28466
Phone (910) 285-7222

2110 S 17th St
Wilmington, NC 28401
Phone (910) 343-5250

Organizations & group practices 3

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": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1811964638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N NORWOOD ST",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284662730",
            "telephone_number": "910-285-7222",
            "fax_number": "910-285-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 N NORWOOD ST",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284662730",
            "telephone_number": "910-285-7222",
            "fax_number": "910-285-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUXEDER",
        "first_name": "MARYANN",
        "middle_name": "E.",
        "credential": "DC OF CHIROPRACTIC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUES",
            "identifier": "HIGHMARK",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallace, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.