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General NPI Number Information
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NPI Number | 1750027298
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Entity Type | Organization
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Legal Business Name | GADDIS CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 100 HIGHWAY 15 S STE 138
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City | JACKSON
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State | KY
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Zip | 41339-8636
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Country | US
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Telephone | 606-272-6227
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HIGHWAY 15 S STE 138
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City | JACKSON
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State | KY
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Zip | 41339-8636
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Country | US
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Telephone | 606-272-6227
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL GADDIS
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Credential | DC
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Telephone | 606-272-6227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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