Provider Demographics
NPI:1487824421
Name:LARIDAEN, DANA (DC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LARIDAEN
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 1:2817 OCEAN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:310-392-3929
Mailing Address - Fax:310-392-3977
Practice Address - Street 1:2817 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2905
Practice Address - Country:US
Practice Address - Phone:310-392-3929
Practice Address - Fax:310-392-3977
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor