Provider Demographics
NPI:1013194232
Name:STEPHEN BRADFORD H'DOUBLER DC PC
Entity Type:Organization
Organization Name:STEPHEN BRADFORD H'DOUBLER DC PC
Other - Org Name:H'DOUBLER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:H'DOUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-889-2400
Mailing Address - Street 1:2101 W CHESTERFIELD BLVD
Mailing Address - Street 2:SUITE A103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6946
Mailing Address - Country:US
Mailing Address - Phone:417-889-2400
Mailing Address - Fax:417-889-2808
Practice Address - Street 1:2101 W CHESTERFIELD BLVD
Practice Address - Street 2:SUITE A103
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6946
Practice Address - Country:US
Practice Address - Phone:417-889-2400
Practice Address - Fax:417-889-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720179955OtherINDIVIDUAL NPI #
U72051Medicare UPIN