Individual
BRAD LEE PROFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS, DC,
Contact information
Practice address
1451 DIEDERICH BLVD, RUSSELL, KY 41169-1718
(606) 388-2173
Mailing address
1451 DIEDERICH BLVD, RUSSELL, KY 41169-1718
(606) 836-6683
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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