Provider Demographics
NPI:1386830875
Name:BRADLEYCHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BRADLEYCHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-369-9144
Mailing Address - Street 1:8556 E 101ST ST
Mailing Address - Street 2:STE. H
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7033
Mailing Address - Country:US
Mailing Address - Phone:918-369-9144
Mailing Address - Fax:918-369-9145
Practice Address - Street 1:8556 E 101ST ST
Practice Address - Street 2:STE. H
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7033
Practice Address - Country:US
Practice Address - Phone:918-369-9144
Practice Address - Fax:918-369-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty