Provider Demographics
NPI:1376876177
Name:BRADLEY, SEAN (ND, LAC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7564 NE 203RD ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2078
Mailing Address - Country:US
Mailing Address - Phone:970-310-5500
Mailing Address - Fax:
Practice Address - Street 1:13501 100TH AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5236
Practice Address - Country:US
Practice Address - Phone:425-820-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60083601171100000X
WANT 60071422175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist