Individual
DR. BRADLEY D ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1526 N ATHERTON ST STE 200, STATE COLLEGE, PA 16803
(814) 237-5220
(412) 291-3381
Mailing address
1526 N ATHERTON ST STE 200, STATE COLLEGE, PA 16803-3041
(814) 237-5220
(412) 291-3381
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC007593L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03081900
CAPITAL BC/BS
—
01
—
347952
HIGHMARK BC/BS
—
Enumeration date
08/31/2006
Last updated
09/25/2019
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