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Individual
MARC BRADLEY
Active
Individual
MARC BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556003
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175344
BLUE CROSS/BLUE SHIELD
VA
05
—
4047000
—
TN
01
—
7647380
AETNA
VA
01
—
VA0104
JOHN DEERE
VA
Enumeration date
09/15/2006
Last updated
07/08/2007
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