Provider Demographics
NPI:1033312665
Name:MATSON, BRADLEY GREEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GREEN
Last Name:MATSON
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 1:7226 W COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9523
Mailing Address - Country:US
Mailing Address - Phone:602-809-6781
Mailing Address - Fax:602-235-2035
Practice Address - Street 1:7226 W COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-9523
Practice Address - Country:US
Practice Address - Phone:602-809-6781
Practice Address - Fax:602-235-2035
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC4558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor