Provider Demographics
NPI:1194807644
Name:FROST, BRADLEY A (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:FROST
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 1:103 RESCIA AVE
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5930
Mailing Address - Country:US
Mailing Address - Phone:256-442-2448
Mailing Address - Fax:256-442-2498
Practice Address - Street 1:103 RESCIA AVE
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5930
Practice Address - Country:US
Practice Address - Phone:256-442-2448
Practice Address - Fax:256-442-2498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU19035Medicare UPIN
ALK424Medicare PIN