Provider Demographics
NPI:1366754467
Name:LEDDEN FAMILY CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:LEDDEN FAMILY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-805-5943
Mailing Address - Street 1:2630 E CHESTNUT AVE STE D8
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8400
Mailing Address - Country:US
Mailing Address - Phone:856-692-2220
Mailing Address - Fax:856-692-2212
Practice Address - Street 1:1081 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4038
Practice Address - Country:US
Practice Address - Phone:856-692-2220
Practice Address - Fax:856-692-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00643300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099112Medicaid
NJV08866Medicare UPIN