Provider Demographics
NPI:1144373945
Name:RICHARDSON, BRADLEY LANE (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LANE
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:303-466-3232
Mailing Address - Fax:303-466-0110
Practice Address - Street 1:54 GARDEN CTR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1730
Practice Address - Country:US
Practice Address - Phone:303-466-3232
Practice Address - Fax:303-466-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 4326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO4326OtherSTATE LICENSE
COCO4326OtherSTATE LICENSE