Provider Demographics
NPI:1619157146
Name:GERHARD, BRADLEY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:PAUL
Last Name:GERHARD
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 1:823 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2752
Mailing Address - Country:US
Mailing Address - Phone:954-565-6333
Mailing Address - Fax:954-565-9913
Practice Address - Street 1:823 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2752
Practice Address - Country:US
Practice Address - Phone:954-565-6333
Practice Address - Fax:954-565-9913
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381704100Medicaid
FL89140AMedicare PIN
FLU666310Medicare UPIN