Provider Demographics
NPI:1447208137
Name:CREEHAN, BRAD J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:J
Last Name:CREEHAN
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 1:100 PRESTON EXECUTIVE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8437
Mailing Address - Country:US
Mailing Address - Phone:919-460-4546
Mailing Address - Fax:
Practice Address - Street 1:100 PRESTON EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8437
Practice Address - Country:US
Practice Address - Phone:919-460-4546
Practice Address - Fax:919-467-5487
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085T5Medicaid
NC085T5OtherBLUE CROSS/BLUE SHIELD
NC085T5OtherBLUE CROSS/BLUE SHIELD
NCVO1991Medicare UPIN