Individual
DERRICK LADEAIROUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DR.
Contact information
Practice address
1732 W GENESEE ST, SYRACUSE, NY 13204
(631) 974-1849
Mailing address
1732 W GENESEE ST, SYRACUSE, NY 13204-1902
(631) 974-1849
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X013188
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467755751
GROUP NPI
NY
Enumeration date
12/17/2018
Last updated
03/06/2019
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