Organization Active NPI

Gaudry Chiropractic PLLC

  • Chiropractor
  • Maryville, TN
National Provider Identifier
1407733710
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
GAUDRY CHIROPRACTIC PLLC
Practice address
424 Home Ave
Maryville, TN 37801-3915
Phone
(802) 353-5980
NPI assigned
Aug 19, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tyler Gaudry, DCNPI 1366146581
Title
Owner
Phone
(802) 353-5980

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

424 Home Ave
Maryville, TN 37801-3915

Mailing address

11555 E Shepperd Ave
Mesa, AZ 85212-4217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251030001514 TN Part B Supplier - Clinic/Group Practice 6800385733 Receives reassigned benefits from 1 practitioner
Practice locations: Maryville, TN

National Provider Directory

National Provider Directory

Locations

424 Home Ave
Maryville, TN 37801
Phone (865) 681-2222

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755561600000",
    "number": "1407733710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 E SHEPPERD AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852124217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 HOME AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378013915",
            "telephone_number": "802-353-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAUDRY CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-19",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "GAUDRY",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-353-5980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.