Provider Demographics
NPI:1154367506
Name:KIRIAKA, BRADLEY D (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:KIRIAKA
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:PO BOX 2402
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-9207
Mailing Address - Country:US
Mailing Address - Phone:208-448-4726
Mailing Address - Fax:
Practice Address - Street 1:314 E ALBENI HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-9207
Practice Address - Country:US
Practice Address - Phone:208-448-4726
Practice Address - Fax:208-448-4726
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor