Bradley Neal Wilson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR010595 Issued in GA

Practice address

2970 Cherokee St NW
Kennesaw, GA 30144-2826

Phone

(770) 694-6619

NPI assigned

Nov 25, 2021

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1637798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1386301240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 SHALLOW CREEK TRL NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 CHEROKEE ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442826",
            "telephone_number": "770-694-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRADLEY",
        "middle_name": "NEAL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-25",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Kyle Willis, D.C.
• Nancy Kay Willis, D.C.
• William N Willis, D.C.
• Lori Brazell Wills, ED.S., CCC-SLP
• Ashley Wilson, PTA
• Daivon Maleke Wilson
• Jesceria Wilson
• Katisha L Wilson, PHARMD
• Suzette Karen Wilson, CMA,PCT,LMT
• Chassity Marie Wiltz

• Chiropractor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.