Provider Demographics
NPI:1740236876
Name:BRADSHAW, SUSAN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WESLAYAN ST STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5751
Mailing Address - Country:US
Mailing Address - Phone:713-337-2117
Mailing Address - Fax:713-337-2118
Practice Address - Street 1:3000 WESLAYAN ST STE 260
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5751
Practice Address - Country:US
Practice Address - Phone:713-337-2117
Practice Address - Fax:713-337-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7605111N00000X
TX10711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU79206Medicare UPIN