Provider Demographics
NPI:1386831055
Name:CASE, BRADFORD DEAN (DC, ND)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:DEAN
Last Name:CASE
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:831-915-6783
Mailing Address - Fax:
Practice Address - Street 1:4110 SORRENTO VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:831-663-2284
Practice Address - Fax:831-663-2288
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1081175F00000X
CA0232200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0232200OtherMEDICARE