Individual
DR. SHANE PATRICK BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
409 WILSON ST, VAN METER, IA 50261-9728
(515) 650-7599
Mailing address
4461 TAMARA LN, WEST DES MOINES, IA 50265-6973
(515) 650-7599
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06587
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I12015
WELLMARK BCBS
IA
Enumeration date
05/21/2007
Last updated
01/22/2020
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