Provider Demographics
NPI:1255384715
Name:LEDDEN, TAMMY L (DC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:LEDDEN
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 1:2821 E LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-3079
Mailing Address - Country:US
Mailing Address - Phone:856-692-2220
Mailing Address - Fax:856-692-2212
Practice Address - Street 1:2821 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-3079
Practice Address - Country:US
Practice Address - Phone:856-692-2220
Practice Address - Fax:856-692-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00643300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099112Medicaid
NJV08866Medicare UPIN
NJ0099112Medicaid