Provider Demographics
NPI:1487650800
Name:WINTER, BRADLEY ROLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROLAND
Last Name:WINTER
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 1:1535 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1753
Mailing Address - Country:US
Mailing Address - Phone:763-689-0462
Mailing Address - Fax:
Practice Address - Street 1:1535 1ST AVE E
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1753
Practice Address - Country:US
Practice Address - Phone:763-689-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350005096Medicare PIN