Provider Demographics
NPI:1598786295
Name:LEEDER, CYNTHIA C (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:C
Last Name:LEEDER
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 1:2725 JEFFERSON STREET
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-434-4615
Mailing Address - Fax:760-434-7191
Practice Address - Street 1:2725 JEFFERSON STREET
Practice Address - Street 2:SUITE 4B
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-434-4615
Practice Address - Fax:760-434-7191
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16463111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0164630OtherBLUE SHIELD OF CA
33-0341875OtherTIN
CAT18340Medicare UPIN