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General NPI Number Information
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NPI Number | 1790942365
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Entity Type | Individual
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Provider Name | BRANDON DENNIS BRADFORD D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 45 N MAIN ST
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City | NEPHI
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State | UT
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Zip | 84648-1401
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Country | US
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Telephone | 435-623-7400
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Fax | 435-623-7500
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | NEPHI
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State | UT
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Zip | 84648-0173
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Country | US
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Telephone | 435-623-7400
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Fax | 435-623-7500
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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 | 6947458-1202
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License Number State | UT
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