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General NPI Number Information
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NPI Number | 1447640768
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Entity Type | Individual
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Provider Name | BRAD ALAN SHALLOW DC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2015
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Last Update Date | 01/24/2015
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Provider Practice Location Address
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Address Line | 120 S WOODLAND BLVD SUITE B
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City | DELAND
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State | FL
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Zip | 32720-5445
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Country | US
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Telephone | 386-341-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 918 TALL PINE DR
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City | PORT ORANGE
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State | FL
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Zip | 32127-4828
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Country | US
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Telephone | 910-231-3457
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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 | CH11338
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License Number State | FL
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