Provider Demographics
NPI:1386715530
Name:LOKKEN, BRADLEY DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DUANE
Last Name:LOKKEN
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 1:1125 VILLA LINDE CT
Mailing Address - Street 2:SUITE # 40
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
Mailing Address - Country:US
Mailing Address - Phone:810-720-2225
Mailing Address - Fax:810-720-1440
Practice Address - Street 1:1125 VILLA LINDE CT
Practice Address - Street 2:SUITE # 40
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-720-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB55083Medicare ID - Type Unspecified
MIBL004278Medicare UPIN