Individual
BRAD LEE PROFITT
Active
Individual
BRAD LEE PROFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS, DC,
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
250594
KY
225100000X
Physical Therapist
Primary
005907
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000216813
ANTHEM 12 DIGIT PIN
KY
01
—
350054419
RR MEDICARE NUMBER
KY
01
—
4402131
UNITED HEALTHCARE
—
01
—
7562230
AETNA
—
05
—
85001504
—
KY
Enumeration date
10/11/2006
Last updated
04/11/2023
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