Provider Demographics
NPI:1750307120
Name:WOODLE, BRADLEY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:WOODLE
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 1:12643 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1317
Mailing Address - Country:US
Mailing Address - Phone:913-643-1771
Mailing Address - Fax:913-643-1775
Practice Address - Street 1:12643 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1317
Practice Address - Country:US
Practice Address - Phone:913-643-1771
Practice Address - Fax:913-643-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08296Medicare UPIN
KSS30E365Medicare ID - Type Unspecified