Provider Demographics
NPI:1891244323
Name:BRIDWELL, AARON (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BRIDWELL
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 1:1509 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4923
Mailing Address - Country:US
Mailing Address - Phone:979-244-2900
Mailing Address - Fax:979-244-4554
Practice Address - Street 1:1509 7TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4923
Practice Address - Country:US
Practice Address - Phone:979-244-2900
Practice Address - Fax:979-244-4554
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14207Medicare UPIN