Provider Demographics
NPI:1548482243
Name:HUBBARD, BRADLEY O (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:O
Last Name:HUBBARD
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 1:1270 SPRINGBROOK RD
Mailing Address - Street 2:STE A
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3971
Mailing Address - Country:US
Mailing Address - Phone:925-938-9303
Mailing Address - Fax:925-938-9304
Practice Address - Street 1:1270 SPRINGBROOK RD
Practice Address - Street 2:STE A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3971
Practice Address - Country:US
Practice Address - Phone:925-938-9303
Practice Address - Fax:925-938-9304
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC30403OtherCHIROPRACTIC LICENSE NUMB
CADC0304030OtherBLUE SHIELD
CADC30403OtherCHIROPRACTIC LICENSE NUMB