Healthcare Provider Details

I. General information

NPI: 1194807644
Provider Name (Legal Business Name): BRADLEY A FROST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 RESCIA AVE
RAINBOW CITY AL
35906-5930
US

IV. Provider business mailing address

103 RESCIA AVE
RAINBOW CITY AL
35906-5930
US

V. Phone/Fax

Practice location:
  • Phone: 256-442-2448
  • Fax: 256-442-2498
Mailing address:
  • Phone: 256-442-2448
  • Fax: 256-442-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1422
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: