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Individual
MR. SHAWN BRADLEY
Active
Individual
MR. SHAWN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2004018211
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192583
BCBS PROVIDER NUMBER
MO
01
—
2247716
FIRST HEALTH PROVIDER #
MO
01
—
228713
GHP PIN
MO
01
—
686170
HEALTHLINK PROVIDER #
MO
01
—
P00453018
MEDICARE RAILROAD PIN
MO
Enumeration date
08/31/2006
Last updated
10/14/2008
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