Provider Demographics
NPI:1134326515
Name:CRADIC, DAVID SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANE
Last Name:CRADIC
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 1:8701 GEORGIA AVE
Mailing Address - Street 2:STE 507
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3723
Mailing Address - Country:US
Mailing Address - Phone:678-360-7669
Mailing Address - Fax:
Practice Address - Street 1:8701 GEORGIA AVE STE 507
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3723
Practice Address - Country:US
Practice Address - Phone:301-608-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor