Provider Demographics
NPI:1467470443
Name:DONAHOE, BRADLEY DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DALE
Last Name:DONAHOE
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 1:22021 SW SHERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9327
Mailing Address - Country:US
Mailing Address - Phone:503-625-2290
Mailing Address - Fax:503-625-6297
Practice Address - Street 1:22021 SW SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9327
Practice Address - Country:US
Practice Address - Phone:503-625-2290
Practice Address - Fax:503-625-6297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-8948111N00000X
OR3047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor