Provider Demographics
NPI:1649336736
Name:BRADBURN, CHRISTOPHER COLE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:COLE
Last Name:BRADBURN
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 1:4025 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7044
Mailing Address - Country:US
Mailing Address - Phone:919-261-0202
Mailing Address - Fax:
Practice Address - Street 1:4025 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7044
Practice Address - Country:US
Practice Address - Phone:919-261-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010845111N00000X
NC3801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010845OtherSTATE LICENSE#
NC3801OtherNC LICENSE
IL782867OtherHEALTHLINK PROVIDER#
ILV11080Medicare UPIN
ILK34424Medicare ID - Type UnspecifiedINDIVIDUAL#