Provider Demographics
NPI:1740864727
Name:BRADSHAW CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BRADSHAW CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-847-2770
Mailing Address - Street 1:3862 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-2230
Mailing Address - Country:US
Mailing Address - Phone:615-847-2770
Mailing Address - Fax:
Practice Address - Street 1:3862 OLD HICKORY BLVD STE C
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-2230
Practice Address - Country:US
Practice Address - Phone:615-847-2770
Practice Address - Fax:615-847-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty