Provider Demographics
NPI:1073644811
Name:WRIGHT, GARY BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRADFORD
Last Name:WRIGHT
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 1:50 S. ANAHEIM BLVD. #250
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2960
Mailing Address - Country:US
Mailing Address - Phone:714-956-2225
Mailing Address - Fax:714-956-5350
Practice Address - Street 1:50 S. ANAHEIM BLVD. #250
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2960
Practice Address - Country:US
Practice Address - Phone:714-956-2225
Practice Address - Fax:714-956-5350
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC023059111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0230590Medicaid
CADC023059OtherSTATE LICENSE