Provider Demographics
NPI:1417031758
Name:BRADLEY, TRAVIS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WAYNE
Last Name:BRADLEY
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 1:8556 E 101ST ST
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor