Healthcare Provider Details

I. General information

NPI: 1891259404
Provider Name (Legal Business Name): BRADLEY STONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CAMBRIDGE CT
WETUMPKA AL
36093-1261
US

IV. Provider business mailing address

21 CAMBRIDGE CT
WETUMPKA AL
36093-1261
US

V. Phone/Fax

Practice location:
  • Phone: 334-514-4977
  • Fax: 334-514-4979
Mailing address:
  • Phone: 334-514-4977
  • Fax: 334-514-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2925
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: