MEDICARE: DR. RICHARD EARL GADD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1017	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0066386	OTHER	TN	BCBSTN

General Provider Information

NPI Number	:	1912037987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EARL GADD D.C.

Provider Business Mailing Address
First Line	:	3047 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4003
Country	:	US
Telephone Number	:	706-866-4553
Fax Number	:	706-866-8348

Provider Business Practice Location Address
First Line	:	3047 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4003
Country	:	US
Telephone Number	:	706-866-4553
Fax Number	:	706-866-8348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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