Provider Demographics
NPI:1356489983
Name:KLAUCKE, BRADFORD RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:RUSSELL
Last Name:KLAUCKE
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 1:900 ROUTE 134
Mailing Address - Street 2:SUITE 3-25
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2575
Mailing Address - Country:US
Mailing Address - Phone:508-385-2120
Mailing Address - Fax:508-385-5292
Practice Address - Street 1:900 ROUTE 134
Practice Address - Street 2:SUITE 3-25
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2575
Practice Address - Country:US
Practice Address - Phone:508-385-2120
Practice Address - Fax:508-385-5292
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35268Medicare ID - Type Unspecified