Provider Demographics
NPI:1780792820
Name:BEYER, BRADLEY DAVID (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:BEYER
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 1:1220 VALLEY FORGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2676
Mailing Address - Country:US
Mailing Address - Phone:610-917-8202
Mailing Address - Fax:610-917-8205
Practice Address - Street 1:1220 VALLEY FORGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2676
Practice Address - Country:US
Practice Address - Phone:610-917-8202
Practice Address - Fax:610-917-8205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003920L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor