Provider Demographics
NPI:1588023048
Name:BRADT, KRISTOPHER MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:MICHAEL
Last Name:BRADT
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 1:77 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1500
Mailing Address - Country:US
Mailing Address - Phone:607-221-1198
Mailing Address - Fax:
Practice Address - Street 1:77 S WEST ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1500
Practice Address - Country:US
Practice Address - Phone:607-221-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013279-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor