Provider Demographics
NPI:1790997971
Name:GLADDIS, SCOTT MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:GLADDIS
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 1:260 CROSSFIELD DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1596
Mailing Address - Country:US
Mailing Address - Phone:859-879-0024
Mailing Address - Fax:859-879-1102
Practice Address - Street 1:260 CROSSFIELD DR UNIT 2
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1596
Practice Address - Country:US
Practice Address - Phone:859-879-0024
Practice Address - Fax:859-879-1102
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00383001Medicare PIN