Provider Demographics
NPI:1538505755
Name:BRADLEY, MALLORY K (DC)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:K
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 LAKE ST.
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041
Mailing Address - Country:US
Mailing Address - Phone:270-472-9550
Mailing Address - Fax:
Practice Address - Street 1:432 LAKE ST.
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041
Practice Address - Country:US
Practice Address - Phone:270-472-9550
Practice Address - Fax:270-282-8081
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5410111N00000X
FLCH10894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor