Provider Demographics
NPI:1023421179
Name:CAROLAN, BRADLEY WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:CAROLAN
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 1:4687 INDIAN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4011
Mailing Address - Country:US
Mailing Address - Phone:913-648-8111
Mailing Address - Fax:888-349-7046
Practice Address - Street 1:4687 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4011
Practice Address - Country:US
Practice Address - Phone:913-648-8111
Practice Address - Fax:888-349-7046
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-01-05421111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
12285054OtherCAQH