Provider Demographics
NPI:1821539719
Name:LEDBETTER, DEJA (DC)
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:
Last Name:LEDBETTER
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 1:1310 SW STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 SW STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2550
Practice Address - Country:US
Practice Address - Phone:515-965-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor