Provider Demographics
NPI:1902853237
Name:BRADSHAW, MICHELLE L (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 CONFERENCE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1991
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:615-859-5577
Practice Address - Street 1:913 CONFERENCE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:615-859-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010839111N00000X
TN2158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor