Provider Demographics
NPI:1518940386
Name:BRADLEY, JASON TROY (DC, ND, IFMCP)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TROY
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DC, ND, IFMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-0399
Mailing Address - Country:US
Mailing Address - Phone:319-466-0026
Mailing Address - Fax:
Practice Address - Street 1:4045 CREST VIEW RD NE
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-9457
Practice Address - Country:US
Practice Address - Phone:319-466-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06258111NN1001X
IANA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0273417Medicaid
IA0273417Medicaid
IAU73937Medicare UPIN