Provider Demographics
NPI:1962265009
Name:MADDOX, JARED (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:MADDOX
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 241857
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1857
Mailing Address - Country:US
Mailing Address - Phone:334-491-1111
Mailing Address - Fax:334-285-4243
Practice Address - Street 1:2441 COBBS FORD RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7763
Practice Address - Country:US
Practice Address - Phone:334-491-1111
Practice Address - Fax:334-285-4243
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor