Individual
MR. SHAWN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1761 JEFFCO BLVD, ARNOLD, MO 63010-2713
(636) 296-1222
(636) 296-1226
Mailing address
1761 JEFFCO BLVD, ARNOLD, MO 63010-2713
(636) 296-1222
(636) 296-1226
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2004018211
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192583
BCBS PROVIDER NUMBER
MO
01
—
2247716
FIRST HEALTH PROVIDER #
MO
01
—
228713
GHP PIN
MO
01
—
686170
HEALTHLINK PROVIDER #
MO
01
—
P00453018
MEDICARE RAILROAD PIN
MO
Enumeration date
08/31/2006
Last updated
10/14/2008
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