Individual
CHAUNCEY BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1616 E MAIN ST STE 207A-1, MESA, AZ 85203-9071
(480) 477-9199
(480) 477-9199
Mailing address
1616 E MAIN ST STE 207A-1, MESA, AZ 85203-9071
(480) 477-9199
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503836
—
AZ
Enumeration date
07/21/2020
Last updated
11/27/2023
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