Provider Demographics
NPI:1063546794
Name:BRADSHAW, PHILIP JAMES (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-750-7447
Mailing Address - Fax:
Practice Address - Street 1:2 GRACEFUL LANE
Practice Address - Street 2:
Practice Address - City:LEVITOWN
Practice Address - State:PA
Practice Address - Zip Code:19055
Practice Address - Country:US
Practice Address - Phone:215-949-9550
Practice Address - Fax:215-949-9550
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006009L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR801050Medicare ID - Type Unspecified
U58292Medicare UPIN