Provider Demographics
NPI:1700350709
Name:BRADDOCK, ERYN MCCALL (DC)
Entity Type:Individual
Prefix:DR
First Name:ERYN
Middle Name:MCCALL
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOW CREEK PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4387
Mailing Address - Country:US
Mailing Address - Phone:903-729-5051
Mailing Address - Fax:
Practice Address - Street 1:100 WILLOW CREEK PKWY STE C
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4387
Practice Address - Country:US
Practice Address - Phone:903-729-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty