Healthcare Provider Details

I. General information

NPI: 1659761716
Provider Name (Legal Business Name): BRADLY GOULD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 HIGHWAY K
O FALLON MO
63368-7979
US

IV. Provider business mailing address

2917 HIGHWAY K STE F
O FALLON MO
63368-7879
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-9105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015001267
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: