Provider Demographics
NPI:1629376454
Name:LEDESMA, DAVID ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:139 BALSAM ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3837
Mailing Address - Country:US
Mailing Address - Phone:760-559-3148
Mailing Address - Fax:760-559-3148
Practice Address - Street 1:203 BALSAM ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3822
Practice Address - Country:US
Practice Address - Phone:760-559-3148
Practice Address - Fax:760-559-3148
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor