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General NPI Number Information
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NPI Number | 1518940386
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Entity Type | Individual
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Provider Name | JASON TROY BRADLEY DC, ND, IFMCP
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1234 SADLER DR
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-4814
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Country | US
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Telephone | 319-530-2050
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Fax | 319-540-8354
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | SOLON
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State | IA
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Zip | 52333-0399
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Country | US
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Telephone | 319-466-0026
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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 | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 06258
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NA
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number | NA
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License Number State | IA
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