Provider Demographics
NPI:1649398074
Name:EMERY, BRADFORD (DC)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:EMERY
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 1:1463 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3613
Mailing Address - Country:US
Mailing Address - Phone:619-474-6800
Mailing Address - Fax:619-474-0623
Practice Address - Street 1:1463 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3613
Practice Address - Country:US
Practice Address - Phone:619-474-6800
Practice Address - Fax:619-474-0623
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor