Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8536046-1202 | UT |
N | 111NR0400X | Rehabilitation Chiropractor | 8536046-1202 | UT |
N | 111NS0005X | Chiropractic Sports Physician | 8536046-1202 | UT |
N | 111NX0100X | Occupational Health | 8536046-1202 | UT |
NPI | 1790022382 |
---|---|
Provider Name | Dr. Bradley Alan Anderson |
First Address | Salt Lake City, UT 84107-2530 |
Second Address | Salt Lake City, UT 84107-2530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2013 |
Last Update Date | 23/01/2018 |