Provider Demographics
NPI:1679591432
Name:MACHARA, BRADLEY M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:M
Last Name:MACHARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 S US HIGHWAY 17/92
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3356
Mailing Address - Country:US
Mailing Address - Phone:386-753-1177
Mailing Address - Fax:386-753-1115
Practice Address - Street 1:27 S US HIGHWAY 17/92
Practice Address - Street 2:SUITE 2
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3356
Practice Address - Country:US
Practice Address - Phone:386-753-1177
Practice Address - Fax:386-753-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22304OtherBLUE CROSS BLUE SHIELD
FL350055647OtherRAILROAD MEDICARE
FL350055647OtherRAILROAD MEDICARE