Provider Demographics
NPI:1093895807
Name:GESSNER, BRADLEY D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:GESSNER
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 1:1300 E COLONY DR
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6159
Mailing Address - Country:US
Mailing Address - Phone:956-781-6116
Mailing Address - Fax:
Practice Address - Street 1:1536 S CAGE BLVD
Practice Address - Street 2:STE 11
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6349
Practice Address - Country:US
Practice Address - Phone:956-781-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10446111N00000X
NE1316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470817279-01Medicaid
NE470817279-01Medicaid