Healthcare Provider Details

I. General information

NPI: 1528450491
Provider Name (Legal Business Name): LARON PLOEDERER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13733 54TH PL N
PLYMOUTH MN
55446-3899
US

IV. Provider business mailing address

13733 54TH PL N
PLYMOUTH MN
55446-3899
US

V. Phone/Fax

Practice location:
  • Phone: 715-977-2487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6902
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: