1003241407 NPI number — DR. FRANCIS BLAKE BRADFORD D.C.

Table of content: DR. FRANCIS BLAKE BRADFORD D.C. (NPI 1003241407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003241407 NPI number — DR. FRANCIS BLAKE BRADFORD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD
Provider First Name:
FRANCIS
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003241407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 W SPRING ST SE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-3686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-438-8990
Provider Business Mailing Address Fax Number:
770-438-1650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 W SPRING ST SE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-3686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-438-8990
Provider Business Practice Location Address Fax Number:
770-438-1650
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIRO009458 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 2301010130 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com