Provider Demographics
NPI:1295501484
Name:KRICK, BRADLEY ROBERT (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:KRICK
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 1:414 CHATOOGA LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3314
Mailing Address - Country:US
Mailing Address - Phone:321-298-0895
Mailing Address - Fax:
Practice Address - Street 1:305 NOAH DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8723
Practice Address - Country:US
Practice Address - Phone:706-253-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor