Provider Demographics
NPI:1790942365
Name:BRADFORD, BRANDON DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DENNIS
Last Name:BRADFORD
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:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-0173
Mailing Address - Country:US
Mailing Address - Phone:435-623-7400
Mailing Address - Fax:435-623-7500
Practice Address - Street 1:45 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1401
Practice Address - Country:US
Practice Address - Phone:435-623-7400
Practice Address - Fax:435-623-7500
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6947458-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor