Provider Demographics
NPI:1679715593
Name:BADER, DEBRA LEE (DC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:BADER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 BROADWAY STE L1
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3168
Mailing Address - Country:US
Mailing Address - Phone:518-886-1289
Mailing Address - Fax:
Practice Address - Street 1:376 BROADWAY STE L1
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3168
Practice Address - Country:US
Practice Address - Phone:518-886-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor