Provider Demographics
NPI:1952685802
Name:PYNE, BRADLEY JOHN (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOHN
Last Name:PYNE
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 1:1103 E BOXELDER RD STE M
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5582
Mailing Address - Country:US
Mailing Address - Phone:307-686-3734
Mailing Address - Fax:307-682-7531
Practice Address - Street 1:405 W BOXELDER RD
Practice Address - Street 2:STE D2
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5313
Practice Address - Country:US
Practice Address - Phone:307-686-3734
Practice Address - Fax:307-682-7531
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor