Provider Demographics
NPI:1366520496
Name:MARSHALL-INMAN, BRADLEY GIBSON (DC)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:GIBSON
Last Name:MARSHALL-INMAN
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 1:11725 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8108
Mailing Address - Country:US
Mailing Address - Phone:425-825-1750
Mailing Address - Fax:425-825-1850
Practice Address - Street 1:11725 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8108
Practice Address - Country:US
Practice Address - Phone:425-825-1750
Practice Address - Fax:425-825-1850
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8854785Medicare ID - Type Unspecified
WAAB38787Medicare ID - Type Unspecified