Provider Demographics
NPI:1922106590
Name:KEVIN G. BRADLEY P.C.
Entity Type:Organization
Organization Name:KEVIN G. BRADLEY P.C.
Other - Org Name:PROFESSIONAL OFFICE OF DR KEVIN G BRADLEY PC,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GARNER
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-689-2424
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-0930
Mailing Address - Country:US
Mailing Address - Phone:918-689-2424
Mailing Address - Fax:918-618-4778
Practice Address - Street 1:640 ALEXANDER DR STE 107
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4013
Practice Address - Country:US
Practice Address - Phone:918-689-2424
Practice Address - Fax:918-618-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3321111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty