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General NPI Number Information
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NPI Number | 1386301240
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Entity Type | Individual
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Provider Name | BRADLEY NEAL WILSON DC
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Gender | Male
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Dates
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Enumeration Date | 11/25/2021
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2970 CHEROKEE ST NW
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City | KENNESAW
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State | GA
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Zip | 30144-2826
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Country | US
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Telephone | 770-694-6619
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Fax |
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Provider Business Mailing Address
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Address Line | 4909 SHALLOW CREEK TRL NW
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City | KENNESAW
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State | GA
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Zip | 30144-1492
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Country | US
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Telephone |
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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 | CHIR010595
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License Number State | GA
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