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General NPI Number Information
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NPI Number | 1104945823
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Entity Type | Individual
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Provider Name | BRADLEY EUGENE HALVERSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 800 W AIRPORT FWY STE 501
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City | IRVING
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State | TX
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Zip | 75062-6312
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Country | US
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Telephone | 972-812-2360
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Fax | 972-812-2369
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Provider Business Mailing Address
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Address Line | 604 HARRISON DR
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City | COPPELL
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State | TX
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Zip | 75019-2717
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Country | US
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Telephone | 214-718-4789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7242
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License Number State | TX
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