Provider Demographics
NPI:1841382561
Name:KIM A. REDDICK, DC, LLC
Entity Type:Organization
Organization Name:KIM A. REDDICK, DC, LLC
Other - Org Name:COMPLETE WELLNESS CENTER OF ORANGE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-775-6879
Mailing Address - Street 1:2415 S VOLUSIA AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7623
Mailing Address - Country:US
Mailing Address - Phone:386-775-6879
Mailing Address - Fax:386-775-0307
Practice Address - Street 1:2415 S VOLUSIA AVE STE A2
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7623
Practice Address - Country:US
Practice Address - Phone:386-775-6879
Practice Address - Fax:386-775-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 363L00000X
FLME58544207Q00000X
FLCH4492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty