Provider Demographics
NPI:1366538035
Name:YOUNG, BRADLEY HAMILTON (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:HAMILTON
Last Name:YOUNG
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 1:6 11TH AVE
Mailing Address - Street 2:SUITE H-3
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1374
Mailing Address - Country:US
Mailing Address - Phone:850-613-2044
Mailing Address - Fax:850-613-6593
Practice Address - Street 1:6 11TH AVENUE
Practice Address - Street 2:SUITE H-3
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579
Practice Address - Country:US
Practice Address - Phone:850-613-2044
Practice Address - Fax:850-613-6593
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL346589700OtherWORKERS COMPENSATION
FL70140Medicare ID - Type Unspecified