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General NPI Number Information
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NPI Number | 1154427300
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Entity Type | Individual
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Provider Name | BRADLEY A DAVIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5650 MEXICO RD STE 20
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City | SAINT PETERS
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State | MO
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Zip | 63376-1696
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Country | US
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Telephone | 636-936-1100
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Fax | 636-936-1655
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Provider Business Mailing Address
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Address Line | 416 HARRINGTON PL
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City | SAINT PETERS
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State | MO
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Zip | 63376-7706
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Country | US
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Telephone | 636-294-1125
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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 | CE006537
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License Number State | MO
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