Provider Demographics
NPI:1013276377
Name:BRADLEY, MATTHEW L (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:BRADLEY
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 1:2440 HWY 95 STE #A
Mailing Address - Street 2:BARNARD CHIROPRACTIC
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-704-2225
Mailing Address - Fax:928-704-0402
Practice Address - Street 1:2440 HWY 95 STE #A
Practice Address - Street 2:BARNARD CHIROPRACTIC
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-704-2225
Practice Address - Fax:928-704-0402
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC8262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor