Provider Demographics
NPI:1053456939
Name:HARRIS, BRADLEY A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:HARRIS
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 1:960 S 24TH ST W STE J
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6450
Mailing Address - Country:US
Mailing Address - Phone:406-652-8442
Mailing Address - Fax:
Practice Address - Street 1:960 S 24TH ST W STE J
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6450
Practice Address - Country:US
Practice Address - Phone:406-652-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40241OtherBCBS
U42600Medicare UPIN
MT40241OtherBCBS