Provider Demographics
NPI:1528396934
Name:ST. JOHN, AMY GRADDY (DC, LMT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:GRADDY
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 W PLANO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5620
Mailing Address - Country:US
Mailing Address - Phone:214-801-0741
Mailing Address - Fax:888-972-1621
Practice Address - Street 1:4011 W PLANO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5620
Practice Address - Country:US
Practice Address - Phone:214-801-0741
Practice Address - Fax:888-972-1621
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT028852225700000X
TX11054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist