Provider Demographics
NPI:1861450934
Name:BRAADT, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BRAADT
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 1:1028 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5444
Mailing Address - Country:US
Mailing Address - Phone:610-776-2005
Mailing Address - Fax:610-776-1475
Practice Address - Street 1:1028 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5444
Practice Address - Country:US
Practice Address - Phone:610-776-2005
Practice Address - Fax:610-776-1475
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001604L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor