Provider Demographics
NPI:1124278817
Name:CRUMP, BRADLEY GLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GLEN
Last Name:CRUMP
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 1:2571 E 10 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2535
Mailing Address - Country:US
Mailing Address - Phone:435-668-2732
Mailing Address - Fax:
Practice Address - Street 1:1275 RED MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6178
Practice Address - Country:US
Practice Address - Phone:435-668-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363699-1202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition