MEDICARE: SARGENT CHIROPRACTIC CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	230002473	MI

General Provider Information

NPI Number	:	1275036279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARGENT CHIROPRACTIC CLINIC PLLC

Provider Business Mailing Address
First Line	:	1341 N JOHNSON ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6257
Country	:	US
Telephone Number	:	989-892-1421
Fax Number	:	989-892-5510

Provider Business Practice Location Address
First Line	:	1341 N JOHNSON ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-6257
Country	:	US
Telephone Number	:	989-892-1421
Fax Number	:	989-892-5510

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEROD MARTIN BRADLEY
Credential	:	DC
Telephone Number	:	989-892-1421

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	06/11/2019

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