Provider Demographics
NPI:1104945823
Name:HALVERSON, BRADLEY EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:EUGENE
Last Name:HALVERSON
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 1:604 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2717
Mailing Address - Country:US
Mailing Address - Phone:214-718-4789
Mailing Address - Fax:
Practice Address - Street 1:800 W AIRPORT FWY
Practice Address - Street 2:STE 501
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6312
Practice Address - Country:US
Practice Address - Phone:972-812-2360
Practice Address - Fax:972-812-2369
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor