Provider Demographics
NPI:1750027298
Name:GADDIS CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:GADDIS CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-272-6227
Mailing Address - Street 1:100 HIGHWAY 15 S STE 138
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-8636
Mailing Address - Country:US
Mailing Address - Phone:606-272-6227
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHWAY 15 S STE 138
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8636
Practice Address - Country:US
Practice Address - Phone:606-272-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100821310Medicaid