Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 170 | AL |
NPI | 1265664288 |
---|---|
Provider Name | Bradley Shields Hilliker |
First Address | Decatur, AL 35603-6314 |
Second Address | Decatur, AL 35603-6314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2009 |
Last Update Date | 05/04/2017 |