Provider Demographics
NPI:1982939831
Name:LADERMANN, DEBROAH STAR (DC)
Entity Type:Individual
Prefix:
First Name:DEBROAH
Middle Name:STAR
Last Name:LADERMANN
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-0717
Mailing Address - Country:US
Mailing Address - Phone:760-414-9700
Mailing Address - Fax:760-414-9707
Practice Address - Street 1:379 RIMHURST CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7033
Practice Address - Country:US
Practice Address - Phone:760-414-9700
Practice Address - Fax:760-414-9707
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19681OtherCALIFORNIA