Provider Demographics
NPI:1811872054
Name:CARSON, BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:CARSON
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 1:9233 E NEVILLE AVE UNIT 1005
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-1503
Mailing Address - Country:US
Mailing Address - Phone:480-492-8320
Mailing Address - Fax:
Practice Address - Street 1:560 W BROWN RD STE 1006
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3222
Practice Address - Country:US
Practice Address - Phone:602-610-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ39-2756366OtherBAC CHIROPRACTIC