Provider Demographics
NPI:1508841750
Name:CADDELL, COLIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:R
Last Name:CADDELL
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 1:3608 W FRIENDLY AVE
Mailing Address - Street 2:204
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4865
Mailing Address - Country:US
Mailing Address - Phone:336-294-1273
Mailing Address - Fax:336-294-1274
Practice Address - Street 1:3608 W FRIENDLY AVE
Practice Address - Street 2:204
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4865
Practice Address - Country:US
Practice Address - Phone:336-294-1273
Practice Address - Fax:336-294-1274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08299OtherBLUE CROSS OF NC NUMBER
NC08299OtherBLUE CROSS OF NC NUMBER
NCT64381Medicare UPIN