Provider Demographics
NPI:1932763646
Name:MUNDORF, BRADLEY (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MUNDORF
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 1:414 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5909
Mailing Address - Country:US
Mailing Address - Phone:704-873-2831
Mailing Address - Fax:
Practice Address - Street 1:414 E FRONT ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5909
Practice Address - Country:US
Practice Address - Phone:704-873-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor