Provider Demographics
NPI:1982202875
Name:CHADWICK, KADIE (AT)
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11892 S QUARRY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7732
Mailing Address - Country:US
Mailing Address - Phone:801-792-6823
Mailing Address - Fax:
Practice Address - Street 1:11892 S QUARRY RIDGE CV
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-7732
Practice Address - Country:US
Practice Address - Phone:801-792-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer