Provider Demographics
NPI:1679977722
Name:BRADLEY, CRISTINA (DC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:STE 308
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2046
Mailing Address - Country:US
Mailing Address - Phone:310-453-8393
Mailing Address - Fax:310-453-8696
Practice Address - Street 1:712 N MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3705
Practice Address - Country:US
Practice Address - Phone:805-449-0061
Practice Address - Fax:805-449-0014
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA32894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor