Provider Demographics
NPI:1821032624
Name:MORRIS, BRADLEY CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:CRAIG
Last Name:MORRIS
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 1:53 PERSIMMONS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7656
Mailing Address - Country:US
Mailing Address - Phone:843-757-7836
Mailing Address - Fax:
Practice Address - Street 1:53 PERSIMMONS ST STE 105
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7656
Practice Address - Country:US
Practice Address - Phone:843-757-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X
IL038009755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06832005OtherBCBS
IL446602OtherHEALTHLINK
IL4367699462056Medicaid
ILK20520Medicare ID - Type Unspecified
IL4367699462056Medicaid