Individual
MARC BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
111 ELM STREET, WEBER CITY, VA 24290
(276) 386-7778
(276) 386-7857
Mailing address
111 ELM STREET, WEBER CITY, VA 24290
(276) 386-7778
(276) 386-7857
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556003
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175344
BLUE CROSS/BLUE SHIELD
VA
05
—
4047000
—
TN
01
—
7647380
AETNA
VA
01
—
VA0104
JOHN DEERE
VA
Enumeration date
09/15/2006
Last updated
07/08/2007
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