Provider Demographics
NPI:1295821072
Name:EADY, BUDDY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BUDDY
Middle Name:LEE
Last Name:EADY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39336
Mailing Address - Country:US
Mailing Address - Phone:601-469-3030
Mailing Address - Fax:601-469-2522
Practice Address - Street 1:500 EAST 3RD ST.
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074
Practice Address - Country:US
Practice Address - Phone:601-469-3030
Practice Address - Fax:601-469-2522
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126310Medicaid
MS350000290Medicare ID - Type Unspecified
MSU91670Medicare UPIN