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General NPI Number Information
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NPI Number | 1518088913
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Entity Type | Individual
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Provider Name | BARRY J. BRADLEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 158 VILLA DI ESTE TER 104
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City | LAKE MARY
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State | FL
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Zip | 32746-1641
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Country | US
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Telephone | 407-929-1231
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Fax | 407-549-5198
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Provider Business Mailing Address
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Address Line | 158 VILLA DI ESTE TERRACE 104
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-929-1231
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Fax | 407-549-5198
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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 | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | CH-3690
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License Number State | FL
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