Provider Demographics
NPI:1437270998
Name:BRADFORD, ANGELA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:HYATT
Other - Last Name:SONNIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1415 STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-4333
Mailing Address - Country:US
Mailing Address - Phone:337-409-0822
Mailing Address - Fax:337-409-0947
Practice Address - Street 1:1415 STEVENSON ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4333
Practice Address - Country:US
Practice Address - Phone:337-409-0822
Practice Address - Fax:337-409-0947
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2313754Medicaid
LA2313754Medicaid