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General NPI Number Information
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NPI Number | 1760643233
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Entity Type | Organization
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Legal Business Name | A.G. BRADDICK, D.C., P.C.
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 1305 1ST ST E
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City | HUMBLE
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State | TX
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Zip | 77338-4925
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Country | US
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Telephone | 281-446-1041
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Fax | 281-446-4885
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Provider Business Mailing Address
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Address Line | 1305 1ST ST E STE A
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City | HUMBLE
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State | TX
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Zip | 77338-4855
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Country | US
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Telephone | 281-446-1041
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Fax | 281-446-4885
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY GEORGE BRADDICK
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Credential | D.C.
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Telephone | 281-446-1041
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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 | 2170
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License Number State | TX
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