Provider Demographics
NPI:1508898545
Name:CHOLODENKO, DEBRA YERMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:YERMAN
Last Name:CHOLODENKO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:YERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:17514 VENTURA BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3893
Mailing Address - Country:US
Mailing Address - Phone:818-995-4300
Mailing Address - Fax:818-995-4301
Practice Address - Street 1:17514 VENTURA BLVD
Practice Address - Street 2:STE 104
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3893
Practice Address - Country:US
Practice Address - Phone:818-995-4300
Practice Address - Fax:818-995-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor