Provider Demographics
NPI:1497930861
Name:HOROSHAK, BRADLEY SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:HOROSHAK
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 1:19 E VERMILION DR
Mailing Address - Street 2:PO 395
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723
Mailing Address - Country:US
Mailing Address - Phone:218-666-5104
Mailing Address - Fax:
Practice Address - Street 1:19 E VERMILION DR
Practice Address - Street 2:PO 395
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723
Practice Address - Country:US
Practice Address - Phone:218-666-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor