Provider Demographics
NPI:1417370917
Name:BRADLEY, GAIL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:MARIE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4001 JUAN TABO BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3979
Mailing Address - Country:US
Mailing Address - Phone:505-234-4165
Mailing Address - Fax:505-359-2206
Practice Address - Street 1:4001 JUAN TABO BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3979
Practice Address - Country:US
Practice Address - Phone:505-234-4165
Practice Address - Fax:505-359-2206
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2074111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic