Provider Demographics
NPI:1336519578
Name:BRADFORD, ALAN (ND)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4424
Mailing Address - Country:US
Mailing Address - Phone:520-510-3678
Mailing Address - Fax:
Practice Address - Street 1:423 N FLORENCE ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4424
Practice Address - Country:US
Practice Address - Phone:520-510-3678
Practice Address - Fax:520-337-7272
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15-1513175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath