Provider Demographics
NPI:1356522007
Name:DAHLAGER, BRADLEY A (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:DAHLAGER
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 1:953 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2603
Mailing Address - Country:US
Mailing Address - Phone:317-214-7218
Mailing Address - Fax:317-214-7213
Practice Address - Street 1:953 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2603
Practice Address - Country:US
Practice Address - Phone:317-214-7218
Practice Address - Fax:317-214-7213
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008672111N00000X
IN08002715A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
9932169OtherBC BS
7674253OtherAETNA
7674253OtherAETNA