Provider Demographics
NPI:1447407747
Name:WILLIAMSON, BRAD P (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:P
Last Name:WILLIAMSON
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 1:9221 E. BASELINE ROAD
Mailing Address - Street 2:SUITE A109 #160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8324
Mailing Address - Country:US
Mailing Address - Phone:480-969-4040
Mailing Address - Fax:480-830-9202
Practice Address - Street 1:4824 E. BASELINE ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4628
Practice Address - Country:US
Practice Address - Phone:480-969-4040
Practice Address - Fax:480-830-9202
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#7086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor