Healthcare Provider Details

I. General information

NPI: 1699703025
Provider Name (Legal Business Name): BRADLEY EUGENE DOPPS CHIROPRACTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 N SOCORA ST STE 200
WICHITA KS
67212-3279
US

IV. Provider business mailing address

200 W DOUGLAS AVE STE 1040
WICHITA KS
67202-3017
US

V. Phone/Fax

Practice location:
  • Phone: 316-202-0045
  • Fax: 316-440-3741
Mailing address:
  • Phone: 316-263-0003
  • Fax: 316-263-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberC3363
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: