Provider Demographics
NPI:1922151901
Name:FRIEL, BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:FRIEL
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 1:1964 SHERIDAN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2541
Mailing Address - Country:US
Mailing Address - Phone:847-681-1920
Mailing Address - Fax:847-681-1921
Practice Address - Street 1:1950 SHERIDAN RD STE 201
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2530
Practice Address - Country:US
Practice Address - Phone:847-681-1920
Practice Address - Fax:847-681-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL252620Medicare PIN