Provider Demographics
NPI:1063625762
Name:BRADFORD D CASE DC A CHIROPRACTIC CORP
Entity type:Organization
Organization Name:BRADFORD D CASE DC A CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-663-2284
Mailing Address - Street 1:17811 COUNTRYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:PRUNEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93907
Mailing Address - Country:US
Mailing Address - Phone:831-663-2284
Mailing Address - Fax:831-663-2288
Practice Address - Street 1:17811 COUNTRYSIDE CT
Practice Address - Street 2:
Practice Address - City:PRUNEDALE
Practice Address - State:CA
Practice Address - Zip Code:93907
Practice Address - Country:US
Practice Address - Phone:831-663-2284
Practice Address - Fax:831-663-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0232200Medicare ID - Type Unspecified