Provider Demographics
NPI:1942390216
Name:COTTON, BRAD ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ANTHONY
Last Name:COTTON
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 1:901 W. GLEN AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 W GLEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4839
Practice Address - Country:US
Practice Address - Phone:309-693-1212
Practice Address - Fax:309-693-1212
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89179Medicare UPIN
ILK53417Medicare PIN