Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301010130 | MI |
Y | 111N00000X | Chiropractor | CHIRO009458 | GA |
NPI | 1003241407 |
---|---|
Provider Name | Dr. Francis Blake Bradford |
First Address | Smyrna, GA 30080-3686 |
Second Address | Smyrna, GA 30080-3686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 07/06/2015 |