Provider Demographics
NPI:1699063024
Name:ZINKEL, BRADLEY T (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:T
Last Name:ZINKEL
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 1:312 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1258
Mailing Address - Country:US
Mailing Address - Phone:608-846-3333
Mailing Address - Fax:608-846-3032
Practice Address - Street 1:312 E NORTH ST
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1258
Practice Address - Country:US
Practice Address - Phone:608-846-3333
Practice Address - Fax:608-846-3032
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4766-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor