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General NPI Number Information
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NPI Number | 1609971241
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Entity Type | Individual
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Provider Name | KEVIN G. BRADLEY CH
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 640 ALEXANDER DR STE 107
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City | EUFAULA
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State | OK
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Zip | 74432-4013
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Country | US
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Telephone | 918-689-2424
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Fax | 918-618-4778
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Provider Business Mailing Address
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Address Line | PO BOX 930 640 ALEXANDER SUITE 107
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City | EUFAULA
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State | OK
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Zip | 74432-0930
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Country | US
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Telephone | 918-689-2424
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Fax | 918-618-4778
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3321
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License Number State | OK
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