Provider Demographics
NPI:1134266034
Name:WILKERSON, BRADLEY KENT (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KENT
Last Name:WILKERSON
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 1:300 MONTVUE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5546
Mailing Address - Country:US
Mailing Address - Phone:865-691-6234
Mailing Address - Fax:865-691-9034
Practice Address - Street 1:300 MONTVUE RD
Practice Address - Street 2:SUITE D
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5546
Practice Address - Country:US
Practice Address - Phone:865-691-6234
Practice Address - Fax:865-691-9034
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4057288OtherBCBS