Provider Demographics
NPI:1003424516
Name:HORTON, BRADLEY RUSSELL (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:RUSSELL
Last Name:HORTON
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7681 DOONE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7882
Mailing Address - Country:US
Mailing Address - Phone:317-370-6650
Mailing Address - Fax:
Practice Address - Street 1:7681 DOONE VALLEY CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7882
Practice Address - Country:US
Practice Address - Phone:317-370-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered