Healthcare Provider Details

I. General information

NPI: 1245315159
Provider Name (Legal Business Name): RANDY LUDERMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HARRISON ST
SHERWOOD OH
43556-0547
US

IV. Provider business mailing address

PO BOX 4547 210 N HARRISON ST
SHERWOOD OH
43556-0547
US

V. Phone/Fax

Practice location:
  • Phone: 419-899-2142
  • Fax: 419-899-2142
Mailing address:
  • Phone: 419-899-2142
  • Fax: 419-899-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1744
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: