Provider Demographics
NPI:1295822500
Name:JOHNSON, BRADLEY M (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:JOHNSON
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 1:351 HITCHCOCK WAY
Mailing Address - Street 2:# B120
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4016
Mailing Address - Country:US
Mailing Address - Phone:805-685-8400
Mailing Address - Fax:805-569-2121
Practice Address - Street 1:351 HITCHCOCK WAY
Practice Address - Street 2:B120
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4016
Practice Address - Country:US
Practice Address - Phone:805-685-8400
Practice Address - Fax:805-569-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC19858OtherCHIROPRACTIC LICENSE
CADC0198580OtherBLUE SHIELD
DC19858OtherCHIROPRACTIC LICENSE
CADC0198580OtherBLUE SHIELD