Healthcare Provider Details

I. General information

NPI: 1053655530
Provider Name (Legal Business Name): BRADLEY CLAY HORNICK C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 MEDICAL CIR
MYRTLE BEACH SC
29572-4122
US

IV. Provider business mailing address

931 MEDICAL CIR
MYRTLE BEACH SC
29572-4122
US

V. Phone/Fax

Practice location:
  • Phone: 843-877-5224
  • Fax:
Mailing address:
  • Phone: 843-877-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: