Provider Demographics
NPI:1285745315
Name:STULTS, BRADLEY R (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:STULTS
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 1:441 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2141
Mailing Address - Country:US
Mailing Address - Phone:203-272-0573
Mailing Address - Fax:203-439-0539
Practice Address - Street 1:441 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2141
Practice Address - Country:US
Practice Address - Phone:203-272-0573
Practice Address - Fax:203-439-0539
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02411Medicare PIN
CT350000992Medicare ID - Type Unspecified