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Individual

MARY LUTHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DC

Contact information

Practice address
411 W SAINT CHARLES RD, VILLA PARK, IL 60181-2432
(630) 691-1234
Mailing address
411 W SAINT CHARLES RD, VILLA PARK, IL 60181-2432

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02232410
BCBSIL
IL
01
P00120402
RR MEDICARE
IL
Enumeration date
03/14/2006
Last updated
03/28/2008
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