Provider Demographics
NPI:1609927821
Name:NELSON, BRADFORD C (DC)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:C
Last Name:NELSON
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 1:9114 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2809
Mailing Address - Country:US
Mailing Address - Phone:414-258-9777
Mailing Address - Fax:414-258-9789
Practice Address - Street 1:9114 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2809
Practice Address - Country:US
Practice Address - Phone:414-258-9777
Practice Address - Fax:414-258-9789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor