| Doctor Name: | BRADLEY JONATHAN REEVES |
| NPI Number: | 1568875649 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OTC, SA |
| License Number: | |
| Business Practice Address: | 109 S Burlington Dr Pueblo West, CO - 810075560 |
| Business Phone Number: | 7197669008 |
| Business Fax Number: | 7197669010 |
| Mailing Address: | 109 S Burlington Dr, PUEBLO WEST |
| State: | CO |
| Postal Code: | 810075560 |
| Phone Number: | 7197669008 |
| Fax Number: | 7197669010 |
| NPI Enumeration Date: | 06/06/2014 |
| NPI Last Update Date: | 06/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |