Provider Demographics
NPI:1083784383
Name:LADICK, MARY AGNES (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AGNES
Last Name:LADICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 ROCKINGHAM RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-624-6100
Mailing Address - Fax:603-624-6122
Practice Address - Street 1:298 ROCKINGHAM RD
Practice Address - Street 2:UNIT 1
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-624-6100
Practice Address - Fax:603-624-6122
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7920807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor