Provider Demographics
NPI:1487761821
Name:LEVINE, BRADFORD QUERIDO (DC)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:QUERIDO
Last Name:LEVINE
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 1:741 LAKE CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5538
Mailing Address - Country:US
Mailing Address - Phone:407-644-4201
Mailing Address - Fax:
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:#215
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-332-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT8-4289Medicare UPIN
FL38356Medicare ID - Type Unspecified