Provider Demographics
NPI:1780866350
Name:GADDIS, JEFFREY BRYANT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRYANT
Last Name:GADDIS
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 1:1204 S 3RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-7679
Mailing Address - Country:US
Mailing Address - Phone:903-887-6882
Mailing Address - Fax:903-887-3868
Practice Address - Street 1:1204 S 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-7679
Practice Address - Country:US
Practice Address - Phone:903-887-6882
Practice Address - Fax:903-887-3868
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU74487OtherUPIN
TX1739377-01Medicaid
00520YMedicare PIN