Provider Demographics
NPI:1093396616
Name:BRADFORD, DARIUS KEMAR (DC)
Entity Type:Individual
Prefix:DR
First Name:DARIUS
Middle Name:KEMAR
Last Name:BRADFORD
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 1:215 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2313
Mailing Address - Country:US
Mailing Address - Phone:641-990-2303
Mailing Address - Fax:
Practice Address - Street 1:215 WEST ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2313
Practice Address - Country:US
Practice Address - Phone:641-990-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6834111N00000X
IA112360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor