Provider Demographics
NPI:1346391265
Name:PEARCE, BRADLEY CRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:CRISTOPHER
Last Name:PEARCE
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:N28W23000 ROUNDY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-7300
Mailing Address - Country:US
Mailing Address - Phone:262-695-9206
Mailing Address - Fax:
Practice Address - Street 1:N28W23000 ROUNDY DR STE 101
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-7300
Practice Address - Country:US
Practice Address - Phone:262-695-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3904-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38955000Medicaid
WI38955000Medicaid