Healthcare Provider Details

I. General information

NPI: 1750599759
Provider Name (Legal Business Name): BRADLEY CARL HERRGORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EAST AVE
LINCOLN CA
95648-2007
US

IV. Provider business mailing address

1105 EAST AVE
LINCOLN CA
95648-2007
US

V. Phone/Fax

Practice location:
  • Phone: 916-645-3890
  • Fax: 916-645-1692
Mailing address:
  • Phone: 916-645-3890
  • Fax: 916-645-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: