Provider Demographics
NPI:1275638629
Name:HAWKINS, BRADLEY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:HAWKINS
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 1:2011 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3302
Mailing Address - Country:US
Mailing Address - Phone:361-729-2225
Mailing Address - Fax:361-729-2483
Practice Address - Street 1:2011 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3302
Practice Address - Country:US
Practice Address - Phone:361-729-2225
Practice Address - Fax:361-729-2483
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096AHMedicaid
TX80231BOtherBCBS
TX42-1612141OtherTAX ID #
TX80231BOtherBCBS
TX0814485-01Medicare ID - Type UnspecifiedMEDICARE