Provider Demographics
NPI:1952619389
Name:J BRADLEY LANDRUM LLC
Entity Type:Organization
Organization Name:J BRADLEY LANDRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-348-1307
Mailing Address - Street 1:130 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7925
Mailing Address - Country:US
Mailing Address - Phone:270-886-3136
Mailing Address - Fax:
Practice Address - Street 1:130 HAMMOND DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-7925
Practice Address - Country:US
Practice Address - Phone:270-886-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty