Katherine Bradley, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096004885 Issued in IL

Practice address

772 Wall St Ste B
O Fallon, IL 62269-1959

Phone

(618) 624-2400

Fax

(618) 624-2407

NPI assigned

Feb 3, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Underwood Chiropractic L.L.C.

  • Chiropractor
  • O Fallon, IL
  • NPI 1679730568
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1073104881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "772 WALL ST STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691959",
            "telephone_number": "618-624-2400",
            "fax_number": "618-624-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "772 WALL ST STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691959",
            "telephone_number": "618-624-2400",
            "fax_number": "618-624-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "KATHERINE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096004885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Jpyce-Ruth Bowman, BEHAVIOR TECHNICIAN
• Tonya L. Bowman, D.M.D.
• Brad McMillin Inc
• Benjamin Nathaniel Bradley
• Gwendolyn Bradley
• Stacy Elizabeth Bragg, OTR
• Darci R Brannan
• Branz Nutrition Counseling
• Sarah Jane Brashear, FNP-C
• Lauren Marie Brauer, DMD

• Athletic Trainer in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.