Provider Demographics
NPI:1407802333
Name:PADDEN, GARY R (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:PADDEN
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:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-0649
Mailing Address - Country:US
Mailing Address - Phone:989-352-8283
Mailing Address - Fax:989-352-5723
Practice Address - Street 1:960 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9178
Practice Address - Country:US
Practice Address - Phone:989-352-8283
Practice Address - Fax:989-352-5723
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP004872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI141702788Medicaid
MI145187243Medicaid
MI950E910550OtherBCBS PROVIDER GROUP NO
MI950E950010OtherBCBS OF MICHIGAN PROV ID
MI145187225Medicaid
MI950E950010OtherBCBS OF MICHIGAN PROV ID
MI145187225Medicaid
MI0P38330Medicare PIN