Provider Demographics
NPI:1679622328
Name:SIKES, BRADLEY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:CHARLES
Last Name:SIKES
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 1:27490 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4993
Mailing Address - Country:US
Mailing Address - Phone:512-858-5677
Mailing Address - Fax:512-858-1905
Practice Address - Street 1:27490 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4993
Practice Address - Country:US
Practice Address - Phone:512-858-5677
Practice Address - Fax:512-858-1905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605008Medicaid
TXU41106Medicare UPIN
TX605008Medicaid