Provider Demographics
NPI:1285811778
Name:BRADLEY, AMY D (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:D
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-9131
Mailing Address - Country:US
Mailing Address - Phone:870-248-0109
Mailing Address - Fax:870-248-0109
Practice Address - Street 1:302 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9131
Practice Address - Country:US
Practice Address - Phone:870-248-0109
Practice Address - Fax:870-248-0109
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor