Provider Demographics
NPI:1386890473
Name:CRAIG, BRADLEY DRU (DC)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DRU
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:BRADLEY
Other - Middle Name:DRU
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 N MAIN AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7200
Mailing Address - Country:US
Mailing Address - Phone:503-492-5606
Mailing Address - Fax:503-492-3635
Practice Address - Street 1:109 N MAIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7200
Practice Address - Country:US
Practice Address - Phone:503-492-5606
Practice Address - Fax:503-492-3635
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor