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General NPI Number Information
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NPI Number | 1700211489
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Entity Type | Organization
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Legal Business Name | BRADLEY CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 301 N MISSOURI AVE SUITE 17
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City | CORNING
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State | AR
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Zip | 72422-1600
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Country | US
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Telephone | 870-378-5689
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 LLOYD WILLIAMS RD
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City | IMBODEN
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State | AR
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Zip | 72434-9456
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Country | US
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Telephone | 870-378-5689
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | LISA BRADLEY
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Credential | D.C.
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Telephone | 870-378-5689
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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 | 16025
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License Number State | AR
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