Provider Demographics
NPI:1831281732
Name:CLUNES, BRADLEY D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:CLUNES
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 1:130 W CLARENDON ST
Mailing Address - Street 2:CHIROPRACTIC CARE
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2335
Mailing Address - Country:US
Mailing Address - Phone:503-656-0362
Mailing Address - Fax:503-656-0182
Practice Address - Street 1:130 W CLARENDON ST
Practice Address - Street 2:CHIROPRACTIC CARE
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2335
Practice Address - Country:US
Practice Address - Phone:503-656-0362
Practice Address - Fax:503-656-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA134907OtherWOKERS COMP
OR8629AOtherQUAL MED NON PART
WA134907OtherWOKERS COMP