Provider Demographics
NPI:1386669273
Name:BRADLEY P GERHARD DC PA
Entity Type:Organization
Organization Name:BRADLEY P GERHARD DC PA
Other - Org Name:GERHARD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GERHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-565-6333
Mailing Address - Street 1:823 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2752
Mailing Address - Country:US
Mailing Address - Phone:954-565-6333
Mailing Address - Fax:954-565-9913
Practice Address - Street 1:823 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2752
Practice Address - Country:US
Practice Address - Phone:954-565-6333
Practice Address - Fax:954-565-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381704100Medicaid
FLK7986OtherMEDICARE GROUP