Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC006385L | PA |
NPI | 1003314337 |
---|---|
Provider Name | Dr. Deborah L'estrange |
First Address | Merion Station, PA 19066-1524 |
Second Address | Ardmore, PA 19003-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |