Provider Demographics
NPI:1811164080
Name:BRADLEY, JOSEPH J (DC, CAD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DC, CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S DURANGO DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2423
Mailing Address - Country:US
Mailing Address - Phone:702-839-3839
Mailing Address - Fax:702-839-3892
Practice Address - Street 1:810 S DURANGO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2423
Practice Address - Country:US
Practice Address - Phone:702-839-3839
Practice Address - Fax:702-839-3892
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU91055Medicare UPIN