Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2074 | NM |
NPI | 1417370917 |
---|---|
Provider Name | Dr. Gail Marie Bradley |
First Address | Albuquerque, NM 87111-3979 |
Second Address | Albuquerque, NM 87111-3979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2014 |
Last Update Date | 22/04/2015 |