Provider Demographics
NPI:1639319551
Name:BRADFORD, KIRK HENRY (DC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:HENRY
Last Name:BRADFORD
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 1:1219 E. DEBBIE LANE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76002
Mailing Address - Country:US
Mailing Address - Phone:817-704-3243
Mailing Address - Fax:
Practice Address - Street 1:1219 E. DEBBIE LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76002
Practice Address - Country:US
Practice Address - Phone:817-704-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155977Medicare PIN