Provider Demographics
NPI:1265594451
Name:BRADLEY, BARBARA C (DC, PT)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:C
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151515 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6645
Mailing Address - Country:US
Mailing Address - Phone:715-845-3775
Mailing Address - Fax:715-848-9015
Practice Address - Street 1:151515 ROBIN LN
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-6645
Practice Address - Country:US
Practice Address - Phone:715-845-3775
Practice Address - Fax:715-848-9015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2483111N00000X
WI2469-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT90597Medicare UPIN
WI35695 0001Medicare ID - Type Unspecified