Healthcare Provider Details

I. General information

NPI: 1518760552
Provider Name (Legal Business Name): GLENDA WOODARD BRADSTOCK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 PRESTON RD STE 350
PLANO TX
75093-7471
US

IV. Provider business mailing address

3308 PRESTON RD STE 350
PLANO TX
75093-7471
US

V. Phone/Fax

Practice location:
  • Phone: 469-855-7239
  • Fax:
Mailing address:
  • Phone: 469-855-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: