Provider Demographics
NPI:1114962453
Name:PFEIFFER, BRADLEY ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ANDREW
Last Name:PFEIFFER
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 1:347 NE KEARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4551
Mailing Address - Country:US
Mailing Address - Phone:541-383-4585
Mailing Address - Fax:541-383-9092
Practice Address - Street 1:347 NE KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4551
Practice Address - Country:US
Practice Address - Phone:541-383-4585
Practice Address - Fax:541-383-9092
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR113827Medicare PIN
ORU92070Medicare UPIN