Provider Demographics
NPI:1265591978
Name:LONDRE, BRAD DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:DAVID
Last Name:LONDRE
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 1:518 S DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5927
Mailing Address - Country:US
Mailing Address - Phone:704-482-7271
Mailing Address - Fax:
Practice Address - Street 1:518 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5927
Practice Address - Country:US
Practice Address - Phone:704-482-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08595OtherBLUE CROSS BLUE SHIELD
NC7908595Medicaid
NCT64543Medicare UPIN
NC08595OtherBLUE CROSS BLUE SHIELD