Provider Demographics
NPI:1801154869
Name:GADDIS, KRISTIE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:GADDIS
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 1:8500 SHOAL CREEK BLVD
Mailing Address - Street 2:BLDG 4, STE 106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7651
Mailing Address - Country:US
Mailing Address - Phone:512-784-9701
Mailing Address - Fax:512-794-6309
Practice Address - Street 1:8500 SHOAL CREEK BLVD
Practice Address - Street 2:BLDG 4, STE 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7651
Practice Address - Country:US
Practice Address - Phone:512-784-9701
Practice Address - Fax:512-794-6309
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor