Provider Demographics
NPI:1699054437
Name:BRADFORD, DAVID EUGENE (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:BRADFORD
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 1:10198 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1448
Mailing Address - Country:US
Mailing Address - Phone:513-772-9065
Mailing Address - Fax:513-772-2961
Practice Address - Street 1:10198 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1448
Practice Address - Country:US
Practice Address - Phone:513-772-9065
Practice Address - Fax:513-772-2961
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4212111N00000X
FLCH10312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor