Provider Demographics
NPI:1417912874
Name:CHANEY, BRADWELL SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:BRADWELL
Middle Name:SCOTT
Last Name:CHANEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TRIVETTE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501
Mailing Address - Country:US
Mailing Address - Phone:606-432-0003
Mailing Address - Fax:606-432-0076
Practice Address - Street 1:126 TRIVETTE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-0003
Practice Address - Fax:606-432-0076
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002405Medicaid
KY80002405Medicaid