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General NPI Number Information
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NPI Number | 1699886390
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Entity Type | Individual
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Provider Name | BRADLEY D ENNIS DC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1526 N ATHERTON ST STE 200
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City | STATE COLLEGE
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State | PA
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Zip | 16803
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Country | US
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Telephone | 814-237-5220
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Fax | 412-291-3381
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Provider Business Mailing Address
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Address Line | 1526 N ATHERTON ST STE 200
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City | STATE COLLEGE
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State | PA
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Zip | 16803-3041
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Country | US
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Telephone | 814-237-5220
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Fax | 412-291-3381
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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 | DC007593L
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License Number State | PA
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