Provider Demographics
NPI:1578706149
Name:DAVID B. BRADLEY, DC, PC
Entity Type:Organization
Organization Name:DAVID B. BRADLEY, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-282-7600
Mailing Address - Street 1:729 W. BEDFORD-EULESS RD
Mailing Address - Street 2:STE 209
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3941
Mailing Address - Country:US
Mailing Address - Phone:817-282-7600
Mailing Address - Fax:817-282-7604
Practice Address - Street 1:729 W. BEDFORD-EULESS RD
Practice Address - Street 2:STE 209
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3941
Practice Address - Country:US
Practice Address - Phone:817-282-7600
Practice Address - Fax:817-282-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4883Medicare PIN