Individual
MR. JACK EMERY BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
101 N UNCOMPAHGRE, SUITE 1, MONTROSE, CO 81401
(970) 252-8255
(970) 252-9280
Mailing address
101 N UNCOMPAHGRE, SUITE 1, MONTROSE, CO 81401
(970) 252-8255
(970) 252-9280
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHR3842
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800840
GROUP NUMBER
CO
Enumeration date
05/02/2007
Last updated
07/09/2007
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