Provider Demographics
NPI:1801986229
Name:TINKER, BRADLEY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALLEN
Last Name:TINKER
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 1:3800 W RAY RD
Mailing Address - Street 2:#5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5940
Mailing Address - Country:US
Mailing Address - Phone:480-831-1478
Mailing Address - Fax:480-831-3982
Practice Address - Street 1:3800 W RAY RD
Practice Address - Street 2:#5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5940
Practice Address - Country:US
Practice Address - Phone:480-831-1478
Practice Address - Fax:480-831-3982
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0245470OtherBCBS
AZAZ0245470OtherBCBS