Provider Demographics
NPI:1891820643
Name:BRADEN, MICHAEL T (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BRADEN
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 1:517 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6757
Mailing Address - Country:US
Mailing Address - Phone:732-341-4900
Mailing Address - Fax:732-960-5044
Practice Address - Street 1:517 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6757
Practice Address - Country:US
Practice Address - Phone:732-341-4900
Practice Address - Fax:732-960-5044
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00591700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053956Medicare PIN