=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366754467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEDDEN FAMILY CHIROPRACTIC CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2010
-----------------------------------------------------
Last Update Date | 12/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1081 E LANDIS AVE
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-2220
-----------------------------------------------------
Fax | 856-692-2212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 E CHESTNUT AVE STE D8
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08361-8400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-692-2220
-----------------------------------------------------
Fax | 856-692-2212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. TAMMY L LEDDEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 609-805-5943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00643300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------