Provider Demographics
NPI:1952420366
Name:BRADDOCK, CALEB CLIFFORD (DC)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:CLIFFORD
Last Name:BRADDOCK
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:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-1782
Mailing Address - Country:US
Mailing Address - Phone:903-482-1234
Mailing Address - Fax:903-482-1232
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495
Practice Address - Country:US
Practice Address - Phone:903-482-1234
Practice Address - Fax:903-482-1232
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X8450OtherBLUE CROSS
TX8F8675Medicare PIN
TX612233Medicare ID - Type Unspecified