MEDICARE: DR. PETER LEE LADD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	003388	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	003388	OTHER	MN	CHIROPRACTIC LICENSCE

General Provider Information

NPI Number	:	1881726040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER LEE LADD D.C.

Provider Business Mailing Address
First Line	:	1089 ROBERT ST S
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-1456
Country	:	US
Telephone Number	:	651-457-5435
Fax Number	:	651-457-8091

Provider Business Practice Location Address
First Line	:	1089 ROBERT ST S
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-1456
Country	:	US
Telephone Number	:	651-457-5435
Fax Number	:	651-457-8091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	11/08/2012

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