Provider Demographics
NPI:1649631581
Name:WELLNITZ, BRADFORD (DC)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:WELLNITZ
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 1:2234 FLETCHER PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2234 FLETCHER PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2114
Practice Address - Country:US
Practice Address - Phone:619-464-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor