Provider Demographics
NPI:1013901446
Name:BRADLEY, DENNIS J (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
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 1:214 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1602
Mailing Address - Country:US
Mailing Address - Phone:319-378-1515
Mailing Address - Fax:319-378-9292
Practice Address - Street 1:214 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1602
Practice Address - Country:US
Practice Address - Phone:319-378-1515
Practice Address - Fax:319-378-9292
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1149021Medicaid
IA48468OtherBLUE CROSS BLUE SHIELD
IA1149021Medicaid
IA48468Medicare ID - Type Unspecified