Provider Demographics
NPI:1508006537
Name:VOLLMER, BRAD MARSHAL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MARSHAL
Last Name:VOLLMER
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 1:685 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2117
Mailing Address - Country:US
Mailing Address - Phone:503-367-4266
Mailing Address - Fax:503-908-1002
Practice Address - Street 1:685 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2117
Practice Address - Country:US
Practice Address - Phone:503-367-4266
Practice Address - Fax:503-908-1002
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3867111N00000X
WACH60043825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor