Provider Demographics
NPI:1689132169
Name:ANNAS, BRADLEY (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:ANNAS
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 1:2065 CLEARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1015
Mailing Address - Country:US
Mailing Address - Phone:586-457-0234
Mailing Address - Fax:
Practice Address - Street 1:52935 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-3266
Practice Address - Country:US
Practice Address - Phone:586-457-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty