Healthcare Provider Details

I. General information

NPI: 1073644811
Provider Name (Legal Business Name): GARY BRADFORD WRIGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S. ANAHEIM BLVD. #250
ANAHEIM CA
92805-2960
US

IV. Provider business mailing address

50 S. ANAHEIM BLVD. #250
ANAHEIM CA
92805-2960
US

V. Phone/Fax

Practice location:
  • Phone: 714-956-2225
  • Fax: 714-956-5350
Mailing address:
  • Phone: 714-956-2225
  • Fax: 714-956-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC023059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: