Provider Demographics
NPI:1518088913
Name:BRADLEY, BARRY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:BRADLEY
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 1:158 VILLA DI ESTE TERRACE
Mailing Address - Street 2:104
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:407-929-1231
Mailing Address - Fax:407-549-5198
Practice Address - Street 1:158 VILLA DI ESTE TER
Practice Address - Street 2:104
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1641
Practice Address - Country:US
Practice Address - Phone:407-929-1231
Practice Address - Fax:407-549-5198
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-3690111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition