Provider Demographics
NPI:1417932930
Name:KEY, BRADLEY V (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:V
Last Name:KEY
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 1:1015 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-9141
Mailing Address - Country:US
Mailing Address - Phone:765-964-5306
Mailing Address - Fax:765-964-7301
Practice Address - Street 1:1015 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-9141
Practice Address - Country:US
Practice Address - Phone:765-964-5306
Practice Address - Fax:765-964-7301
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2446111N00000X
IN08001762A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200422060Medicaid
OHKE0828251Medicare ID - Type Unspecified
IN200422060Medicaid