Individual
DR. BRADLEY A TACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5131 US HIGHWAY 62, CALVERT CITY, KY 42029-8390
(270) 395-4540
(270) 395-7715
Mailing address
330 OAK SHADOW LN, BENTON, KY 42025-5494
(270) 527-8216
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4306
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3500051847
RRMEDICARE
KY
05
—
85000685
—
KY
Enumeration date
08/09/2005
Last updated
07/09/2007
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