Provider Demographics
NPI:1992871354
Name:PENNINGTON, BRADLEY (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:PENNINGTON
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 1:2450 E 5TH AVE
Mailing Address - Street 2:# K
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4268
Mailing Address - Country:US
Mailing Address - Phone:970-688-0097
Mailing Address - Fax:
Practice Address - Street 1:94 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3616
Practice Address - Country:US
Practice Address - Phone:303-820-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor