Provider Demographics
NPI:1407813520
Name:LADD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LADD FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:815-894-9400
Mailing Address - Street 1:206 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LADD
Mailing Address - State:IL
Mailing Address - Zip Code:61329-9647
Mailing Address - Country:US
Mailing Address - Phone:815-894-9400
Mailing Address - Fax:815-894-9403
Practice Address - Street 1:206 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LADD
Practice Address - State:IL
Practice Address - Zip Code:61329-9647
Practice Address - Country:US
Practice Address - Phone:815-894-9400
Practice Address - Fax:815-894-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK32971Medicare PIN
IL214394Medicare PIN
ILU95616Medicare UPIN