Provider Demographics
NPI:1932474160
Name:BADDERS, JEDEDIAH DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:DANIEL
Last Name:BADDERS
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 1:900B S WALTON BLVD STE 19
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6362
Mailing Address - Country:US
Mailing Address - Phone:479-268-3992
Mailing Address - Fax:479-268-4035
Practice Address - Street 1:900B S WALTON BLVD STE 19
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6362
Practice Address - Country:US
Practice Address - Phone:479-268-3992
Practice Address - Fax:479-268-4035
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20004460Medicare UPIN