Individual
BRADFORD CHANDLER BAISDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
823 PARK EAST BLVD STE B, LAFAYETTE, IN 47905-0811
(765) 297-0975
(765) 297-0974
Mailing address
823 PARK EAST BLVD STE B, LAFAYETTE, IN 47905-0811
(765) 297-0975
(765) 297-0974
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
10165
NC
225100000X
Physical Therapist
Primary
05011714A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079XN
BCBS PROVIDER NUMBER
NC
Enumeration date
07/10/2006
Last updated
11/14/2022
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