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General NPI Number Information
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NPI Number | 1780806737
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Entity Type | Organization
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Legal Business Name | GOOD NEWS CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 101 N UNCOMPAHGRE SUITE 1
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-252-8255
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Fax | 970-252-9280
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Provider Business Mailing Address
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Address Line | 101 N UNCOMPAHGRE SUITE 1
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-252-8255
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Fax | 970-252-9280
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. JACK EMERY BRADLEY
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Credential | DC
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Telephone | 970-252-8255
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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 | CHR3842
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License Number State | CO
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