Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 0104-557699 | VA |
Y | 111N00000X | Chiropractor | S03862 | MD |
N | 111NN1001X | Nutrition | S03862 | MD |
N | 111NP0017X | Pediatric Chiropractor | S03862 | MD |
N | 111NR0400X | Rehabilitation Chiropractor | S03862 | MD |
N | 111NS0005X | Chiropractic Sports Physician | S03862 | MD |
NPI | 1497110779 |
---|---|
Provider Name | Joi Gaddy |
First Address | Columbia, MD 21045-2614 |
Second Address | Columbia, MD 21046-2394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2015 |
Last Update Date | 15/04/2021 |