Provider Demographics
NPI:1891800850
Name:LEDERMAN, SETH (DC)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W CHICAGO AVE
Mailing Address - Street 2:RIVER WALK #4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6758
Mailing Address - Country:US
Mailing Address - Phone:312-644-4500
Mailing Address - Fax:312-644-4501
Practice Address - Street 1:600 W CHICAGO AVE
Practice Address - Street 2:RIVER WALK #4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6758
Practice Address - Country:US
Practice Address - Phone:312-644-4500
Practice Address - Fax:312-644-4501
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT91866Medicare UPIN
ILK12566Medicare ID - Type Unspecified