Provider Demographics
NPI:1245315159
Name:LUDERMAN, RANDY (DC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:LUDERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4547
Mailing Address - Street 2:210 N HARRISON ST
Mailing Address - City:SHERWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43556-0547
Mailing Address - Country:US
Mailing Address - Phone:419-899-2142
Mailing Address - Fax:419-899-2142
Practice Address - Street 1:210 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OH
Practice Address - Zip Code:43556-0547
Practice Address - Country:US
Practice Address - Phone:419-899-2142
Practice Address - Fax:419-899-2142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-1838101OtherFEDERAL ID#
OHP00080876OtherRAILROAD MEDICARE
OH000000143198OtherANTHEM INSURANCE
OH35-1838101OtherFEDERAL ID#