Provider Demographics
NPI:1740365899
Name:BRADDICK, ANTHONY GEORGE (DC, PC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGE
Last Name:BRADDICK
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:G
Other - Last Name:BRADDICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC,PC
Mailing Address - Street 1:1305 1ST ST E
Mailing Address - Street 2:A
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4925
Mailing Address - Country:US
Mailing Address - Phone:281-446-1041
Mailing Address - Fax:281-446-4885
Practice Address - Street 1:1305 1ST ST E
Practice Address - Street 2:A
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4925
Practice Address - Country:US
Practice Address - Phone:281-446-1041
Practice Address - Fax:281-446-4885
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00665372OtherMEDICARE RAILROAD
TX8F22499Medicare PIN