Bradford, Chauncey

Bradford, Chauncey is an individual health care provider with primary practice located at 1616 E Main St Ste 207A-1 , Mesa AZ 85203-9071. He recently has only one registered license in Other Service Providers / Peer Specialist, which is considered as his primary health care specialty. Bradford, Chauncey can be contacted via phone (480) 477-9199.

Contact Information

Primary practice address
1616 E Main St Ste 207A-1 Mesa AZ 85203-9071
Phone: (480) 477-9199
Fax: (480) 477-9199
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X Arizona

Profile Details

NPI number 1508474917
LBN Legal business name Bradford, Chauncey
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2020
Last updated Nov 27th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508474917 NPPES
Arizona MEDICAID 503836

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