Healthcare Provider Details

I. General information

NPI: 1033219761
Provider Name (Legal Business Name): BRADLEY STAUFFER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 VILLAGE SQ
GRETNA NE
68028-7914
US

IV. Provider business mailing address

826 VILLAGE SQ
GRETNA NE
68028-7914
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-4808
  • Fax: 402-332-4808
Mailing address:
  • Phone: 402-332-4808
  • Fax: 402-332-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1131
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: