Provider Demographics
NPI:1174715585
Name:BORNE, BRADLEY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALLEN
Last Name:BORNE
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 1:883 AVE OF THE AMERICAS
Mailing Address - Street 2:GOLF & BODY NYC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-244-2626
Mailing Address - Fax:212-244-2663
Practice Address - Street 1:883 AVE OF THE AMERICAS
Practice Address - Street 2:GOLF & BODY NYC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-244-2626
Practice Address - Fax:212-244-2663
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor