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General NPI Number Information
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NPI Number | 1841382561
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Entity Type | Organization
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Legal Business Name | KIM A. REDDICK, DC, LLC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 2415 S VOLUSIA AVE STE A2
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City | ORANGE CITY
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State | FL
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Zip | 32763-7623
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Country | US
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Telephone | 386-775-6879
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Fax | 386-775-0307
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Provider Business Mailing Address
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Address Line | 2415 S VOLUSIA AVE STE A2
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City | ORANGE CITY
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State | FL
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Zip | 32763-7623
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Country | US
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Telephone | 386-775-6879
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Fax | 386-775-0307
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. LEONARD A. ROLLMAN
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Credential | DC
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Telephone | 386-775-6879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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