Provider Demographics
NPI:1770174484
Name:BRADBURY, ERYN (DC)
Entity type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1214
Mailing Address - Country:US
Mailing Address - Phone:720-334-1342
Mailing Address - Fax:
Practice Address - Street 1:310 MOUNTAIN AVE STE D
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-5004
Practice Address - Country:US
Practice Address - Phone:720-334-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor