Provider Demographics
NPI:1942273842
Name:DUNLAP, BRAD J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:J
Last Name:DUNLAP
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 1:2701 ST. HWY 29
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095
Mailing Address - Country:US
Mailing Address - Phone:518-725-4114
Mailing Address - Fax:518-725-4115
Practice Address - Street 1:2701 ST. HWY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4042
Practice Address - Country:US
Practice Address - Phone:518-725-4114
Practice Address - Fax:518-725-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010559111N00000X
NYX-010559-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74-3126753OtherEIN
NY74-3126753OtherEIN
NYIA0885Medicare UPIN