Provider Demographics
NPI:1033198007
Name:PEERBOLTE, BRADLEY
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:PEERBOLTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17027 BEL RAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5371
Mailing Address - Country:US
Mailing Address - Phone:816-425-7015
Mailing Address - Fax:816-425-2117
Practice Address - Street 1:404 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1250
Practice Address - Country:US
Practice Address - Phone:712-243-1554
Practice Address - Fax:712-243-1573
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor