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General NPI Number Information
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NPI Number | 1366030348
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Entity Type | Individual
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Provider Name | BRADLEY CRYE DC
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Gender | Male
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 506 N GARDEN ST
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City | COLUMBIA
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State | TN
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Zip | 38401-3220
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Country | US
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Telephone | 931-490-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 2503 PALOMAR CIR APT S03
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City | COLUMBIA
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State | TN
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Zip | 38401-1066
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Country | US
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Telephone | 928-257-7771
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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 | 3373
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License Number State | TN
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