Provider Demographics
NPI:1629217864
Name:LANDRUM, JOHN BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADLEY
Last Name:LANDRUM
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 1:130 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7925
Mailing Address - Country:US
Mailing Address - Phone:270-348-1307
Mailing Address - Fax:
Practice Address - Street 1:130 HAMMOND DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-7925
Practice Address - Country:US
Practice Address - Phone:270-348-1307
Practice Address - Fax:270-890-6068
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor