Provider Demographics
NPI:1174589915
Name:CLOW, BRADLEY J E (DC, PA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J E
Last Name:CLOW
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PALM BAY RD NE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8601
Mailing Address - Country:US
Mailing Address - Phone:321-725-8778
Mailing Address - Fax:321-984-5299
Practice Address - Street 1:145 PALM BAY RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8601
Practice Address - Country:US
Practice Address - Phone:321-725-8778
Practice Address - Fax:321-984-5299
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70199ZMedicare PIN
FLT94406Medicare UPIN