Provider Demographics
NPI:1710903851
Name:GADDIS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GADDIS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-887-6882
Mailing Address - Street 1:1204 S THIRD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147
Mailing Address - Country:US
Mailing Address - Phone:903-887-6882
Mailing Address - Fax:903-887-3868
Practice Address - Street 1:1204 S THIRD ST
Practice Address - Street 2:STE 102
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147
Practice Address - Country:US
Practice Address - Phone:903-887-6882
Practice Address - Fax:903-887-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8000520YMedicare ID - Type Unspecified
U74487Medicare UPIN