Provider Demographics
NPI:1962461962
Name:BRADLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:BRADLEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-582-8451
Mailing Address - Street 1:7720 SHEDHORN DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:BOSEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8108
Mailing Address - Country:US
Mailing Address - Phone:406-582-8451
Mailing Address - Fax:406-582-8471
Practice Address - Street 1:7720 SHEDHORN DRIVE SUITE B
Practice Address - Street 2:
Practice Address - City:BOSEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8108
Practice Address - Country:US
Practice Address - Phone:406-582-8451
Practice Address - Fax:406-582-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40791OtherBLUE CROSS BLUE SHIELD