Provider Demographics
NPI:1558590802
Name:BRADSHAW, PEGGY (DC)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:BRADSHAW
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:PO BOX 51644
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1644
Mailing Address - Country:US
Mailing Address - Phone:505-401-1178
Mailing Address - Fax:
Practice Address - Street 1:624 FLINT RIDGE TRL SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1088
Practice Address - Country:US
Practice Address - Phone:505-401-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor