Provider Demographics
NPI:1710915426
Name:EICHWALD, BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:EICHWALD
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 1:595A RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342-9758
Mailing Address - Country:US
Mailing Address - Phone:413-584-8708
Mailing Address - Fax:
Practice Address - Street 1:2 BAY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9511
Practice Address - Country:US
Practice Address - Phone:413-587-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2676111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA665294OtherACN
MA3136481OtherAETNA
MAY36874OtherBLUE CROSS BLUE SHIELD
MAU 90187Medicare UPIN
MA665294OtherACN