Healthcare Provider Details

I. General information

NPI: 1982364642
Provider Name (Legal Business Name): BRADFORD CHARLES EATON NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WASHINGTON ST
CLAREMONT NH
03743-5512
US

IV. Provider business mailing address

PO BOX 411
CLAREMONT NH
03743-0411
US

V. Phone/Fax

Practice location:
  • Phone: 860-577-2407
  • Fax:
Mailing address:
  • Phone: 860-395-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: