Doctor Name: | SHANE PATRICK BRADLEY |
NPI Number: | 1679782171 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 06587 |
Business Practice Address: | 1020 Ken Pratt Blvd Unit G Longmont, CO - 805016375 |
Business Phone Number: | 3037728311 |
Business Fax Number: | 3037728558 |
Mailing Address: | 1546 Judson Dr, LONGMONT |
State: | CO |
Postal Code: | 805012537 |
Phone Number: | 5156507599 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 03/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 06587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |