Provider Demographics
NPI:1861827503
Name:HASLAM, BRADLEY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DAVID
Last Name:HASLAM
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:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-1133
Mailing Address - Country:US
Mailing Address - Phone:509-935-6822
Mailing Address - Fax:509-935-4588
Practice Address - Street 1:201 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-5012
Practice Address - Country:US
Practice Address - Phone:509-935-6822
Practice Address - Fax:509-935-4588
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60404828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor