Provider Demographics
NPI:1952451213
Name:LEDFORD, ERIC JEROME (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JEROME
Last Name:LEDFORD
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 1:800 AIRPORT RD
Mailing Address - Street 2:STE 103
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-6469
Mailing Address - Country:US
Mailing Address - Phone:302-422-0622
Mailing Address - Fax:302-424-8448
Practice Address - Street 1:8483 FISHERS CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2318
Practice Address - Country:US
Practice Address - Phone:317-576-9620
Practice Address - Fax:317-576-9621
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001780A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU81201Medicare UPIN
IN161050AMedicare ID - Type Unspecified