Provider Demographics
NPI:1841234036
Name:BURKE, BRADLEY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:PAUL
Last Name:BURKE
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 1:13350 S SUNLAND GIN RD
Mailing Address - Street 2:SUITE B4
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85223-0789
Mailing Address - Country:US
Mailing Address - Phone:520-494-1000
Mailing Address - Fax:520-494-1001
Practice Address - Street 1:13350 S SUNLAND GIN RD
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85223-0789
Practice Address - Country:US
Practice Address - Phone:520-494-1000
Practice Address - Fax:520-494-1001
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ65101Medicare UPIN