Provider Demographics
NPI:1477691624
Name:BRADFORD CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:BRADFORD CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:410-744-2040
Mailing Address - Street 1:401 LITTLE MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3871
Mailing Address - Country:US
Mailing Address - Phone:410-570-3193
Mailing Address - Fax:
Practice Address - Street 1:401 LITTLE MARVEL CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3871
Practice Address - Country:US
Practice Address - Phone:410-570-3193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1460261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53490607OtherBCBS PPO
MD640073OtherUNITED HEALTHCARE
MDN0490001OtherBCBS FEDERAL BLUE CHOIC
MD1150334OtherAETNA HMO
MD5236136OtherAETNA PPO
MD5236136OtherAETNA PPO