DR. BRADLEY D ENNIS (NPI# 1699886390) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699886390 |
| Entity Type | Individual |
| Full Name | DR. BRADLEY D ENNIS |
| Credential | DC |
| Practice Address |
1526 N Atherton St Ste 200 State College PA 16803 |
| Mailing Address |
1526 N Atherton St Ste 200 State College PA 16803-3041 |
| Practice Telephone | 8142375220 |
| Practice Fax Number | 4122913381 |
| Mailing Telephone | 8142375220 |
| Mailing Fax Number | 4122913381 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-09-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | DC007593L | PA | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CAPITAL BC/BS | 03081900 | 01 | |
| HIGHMARK BC/BS | 347952 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1526 N Atherton St Ste 200, State College, PA 16803 | 8142375220 | 4122913381 |
| Street Address |
1526 N ATHERTON ST STE 200 |
| City | STATE COLLEGE |
| State | PA |
| Zip Code | 16803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235780909 | Ennis Straight Chiropractic Center | Chiropractor | 1526 N Atherton St Ste 200, State College, PA 16803-3041 | 2019-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851581 | Tammy Lynn Terosky | Massage Therapist | 2134 Sandy Drive, Suite 6, State College, PA 16803 | 2020-08-12 |
| 1548748973 | Molly Gomez | Occupational Therapist | 260 Lions Hill Road, State College, PA 16803 | 2018-07-28 |
| 1568981827 | David Scott Kautz | Pharmacist | 1665 North Atherton Place, State College, PA 16803 | 2017-09-18 |
| 1245751023 | Zenovia Tarmohamed | Student in an Organized Health Care Education/Training Program | 1850 East Park Avenue, Suite 207, Penn State Health At Mount Nittany Medical Center, State College, PA 16803 | 2017-06-30 |
| 1407205362 | Alka Sood | Student in an Organized Health Care Education/Training Program | 1850 E. Park Avenue, State College, PA 16803 | 2016-06-10 |
| 1588018766 | Daniel Frankel | Student in an Organized Health Care Education/Training Program | 1850 East Park Avenue, Suite 207, State College, PA 16803 | 2016-04-14 |
| 1154791903 | Megan Widener | Physician Assistant | 2520 Green Tech Dr., Ste. D, State College, PA 16803 | 2015-10-05 |
| 1114301330 | Phuong Tran Courtney | Physician Assistant | 1613 North Atherton Street, Suite B, State College, PA 16803 | 2015-07-17 |
| 1164806840 | Amit Thatte | Student in an Organized Health Care Education/Training Program | 1850 East Park Ave., Suite 207, Penn State Hershey Medical Group, State College, PA 16803 | 2015-07-13 |
| 1245588946 | Phoenix Rehabilitation and Health Services, Inc. | Chiropractor | 1700 Old Gatesburg Road, Suite 210, State College, PA 16803 | 2012-08-28 |
| Find all providers in zip 16803 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063029718 | Power Forward Chiropractic LLC | Chiropractor | 138 W Whitehall Rd, State College, PA 16801-5931 | 2020-09-27 |
| 1881232056 | Backcountry Spine and Sport | Chiropractor | 270 Walker Dr Ste 100w, State College, PA 16801-7097 | 2019-12-18 |
| 1982247375 | Molly Katherine Love | Chiropractor | 611 University Dr Ste 214, State College, PA 16801-6552 | 2019-10-18 |
| 1548625676 | Brummert Family Chiropractic, LLC | Chiropractor | 3051 Enterprise Dr, State College, PA 16801-2756 | 2015-12-16 |
| 1396166369 | Matthew Reyes | Chiropractor | 125 Rolling Ridge Dr, State College, PA 16801-7675 | 2013-12-18 |
| 1245588946 | Phoenix Rehabilitation and Health Services, Inc. | Chiropractor | 1700 Old Gatesburg Road, Suite 210, State College, PA 16803 | 2012-08-28 |
| 1821394701 | Sustus, LLC | Chiropractor | 251 Easterly Pkwy, Bldg 2, State College, PA 16801-6301 | 2011-02-10 |
| 1619108610 | Integrative Health Care Associates | Chiropractor | 1315 W College Ave Ste 200, State College, PA 16801-2776 | 2009-08-07 |
| 1326284704 | Kelly Rene Capers | Chiropractor | 2603 E College Ave Ste B, State College, PA 16801-7542 | 2009-01-06 |
| 1720269095 | Casteel Chiropractic of State College, P.C. | Chiropractor | 129 Moses Thompson Ln, State College, PA 16801-6840 | 2007-11-15 |
| Find all providers in STATE COLLEGE | ||||
| City | STATE COLLEGE |
| Zip Code | 16803 |
Please comment or provide details below to improve the information on DR. BRADLEY D ENNIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.