Provider Demographics
NPI:1760952287
Name:BREDY, ASHLEY NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BREDY
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 1:1919 W GORE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3669
Mailing Address - Country:US
Mailing Address - Phone:580-699-7350
Mailing Address - Fax:580-699-7352
Practice Address - Street 1:1919 W GORE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3669
Practice Address - Country:US
Practice Address - Phone:580-699-7350
Practice Address - Fax:580-699-7352
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty