Healthcare Provider Details

I. General information

NPI: 1962265009
Provider Name (Legal Business Name): JARED MADDOX D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S THREE NOTCH ST
TROY AL
36081-2541
US

IV. Provider business mailing address

419 S THREE NOTCH ST
TROY AL
36081-2541
US

V. Phone/Fax

Practice location:
  • Phone: 334-770-0419
  • Fax:
Mailing address:
  • Phone: 334-770-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2845
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: