Provider Demographics
NPI:1851323216
Name:HOLDEN, BRADLEY GUY
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GUY
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 W WILLIAM CANNON DR STE A102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1976
Mailing Address - Country:US
Mailing Address - Phone:512-301-5996
Mailing Address - Fax:512-301-5692
Practice Address - Street 1:6012 W WILLIAM CANNON DR STE A102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1976
Practice Address - Country:US
Practice Address - Phone:512-301-5996
Practice Address - Fax:512-301-5692
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5994111N00000X
TX10499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F22909Medicare PIN