Provider Demographics
NPI:1144471707
Name:BRADLEY PFEIFFER DC, PC
Entity type:Organization
Organization Name:BRADLEY PFEIFFER DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-383-4585
Mailing Address - Street 1:347 NE KEARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4551
Mailing Address - Country:US
Mailing Address - Phone:541-383-4585
Mailing Address - Fax:541-383-9092
Practice Address - Street 1:347 NE KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4551
Practice Address - Country:US
Practice Address - Phone:541-383-4585
Practice Address - Fax:541-383-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU92070Medicare UPIN
ORR113827Medicare PIN