Healthcare Provider Details

I. General information

NPI: 1609868173
Provider Name (Legal Business Name): BRADFORD THOMAS HERLEHY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SCRUGGS RD
MONETA VA
24121-5199
US

IV. Provider business mailing address

799 LONG ISLAND DR
MONETA VA
24121-1933
US

V. Phone/Fax

Practice location:
  • Phone: 540-721-0044
  • Fax: 540-721-0042
Mailing address:
  • Phone: 540-721-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: