Provider Demographics
NPI:1306179130
Name:FRASER, BRADLEY IAN (DC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:IAN
Last Name:FRASER
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 1:5617 HIGHWAY 153
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4675
Mailing Address - Country:US
Mailing Address - Phone:423-648-0257
Mailing Address - Fax:423-648-0263
Practice Address - Street 1:5617 HIGHWAY 153
Practice Address - Street 2:SUITE 201
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4675
Practice Address - Country:US
Practice Address - Phone:423-648-0257
Practice Address - Fax:423-648-0263
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2476111N00000X
GACHIR008548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor