Provider Demographics
NPI:1548393218
Name:BRADBURY, TIMOTHY KRISVICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KRISVICK
Last Name:BRADBURY
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 1:901 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7006
Mailing Address - Country:US
Mailing Address - Phone:360-714-1185
Mailing Address - Fax:360-714-1159
Practice Address - Street 1:901 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7006
Practice Address - Country:US
Practice Address - Phone:360-714-1185
Practice Address - Fax:360-714-1159
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU60839Medicare UPIN