Provider Demographics
NPI:1447307178
Name:BRADFORD, HERBERT J JR (DC)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:J
Last Name:BRADFORD
Suffix:JR
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 1:401 LITTLE MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3871
Mailing Address - Country:US
Mailing Address - Phone:410-255-1807
Mailing Address - Fax:
Practice Address - Street 1:401 LITTLE MARVEL CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3871
Practice Address - Country:US
Practice Address - Phone:410-255-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3124181OtherACN
MD640073OtherUNITED HEALTHCARE
MD5677062OtherFIRST HEALTH
MD448COtherBLUE CROSS BLUE SHIELD
MD5236136OtherAETNA PPO
MD1150334OtherAETNA HMO
U44912Medicare UPIN
MD5236136OtherAETNA PPO