Provider Demographics
NPI:1407890833
Name:GLADDEN, LEAH RAE (DC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:GLADDEN
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 1:1864 STONEMAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1123
Mailing Address - Country:US
Mailing Address - Phone:805-526-8685
Mailing Address - Fax:
Practice Address - Street 1:990 ENCHANTED WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0915
Practice Address - Country:US
Practice Address - Phone:805-520-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27915Medicare UPIN