Provider Demographics
NPI:1609161447
Name:LEDERBRAND, CHANTEL LEE (DC)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:LEE
Last Name:LEDERBRAND
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 1:32950 SW BRIDGES RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5534
Mailing Address - Country:US
Mailing Address - Phone:503-530-9161
Mailing Address - Fax:
Practice Address - Street 1:446 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4187
Practice Address - Country:US
Practice Address - Phone:503-530-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor