Provider Demographics
NPI:1336368521
Name:HUNTER, BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:HUNTER
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:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-0883
Mailing Address - Country:US
Mailing Address - Phone:920-573-0400
Mailing Address - Fax:920-744-1442
Practice Address - Street 1:2337A JACKSON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1809
Practice Address - Country:US
Practice Address - Phone:920-573-0400
Practice Address - Fax:920-744-1442
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4307-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor