MEDICARE: DR. BRADFORD LEWIS SHULL D.C.

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	005736	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001389	OTHER	MO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	16346025	OTHER	MO	BCBS
3	1457357840	OTHER	MO	NPI

General Provider Information

NPI Number	:	1457357840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADFORD LEWIS SHULL D.C.

Provider Business Mailing Address
First Line	:	202 S INDIANA ST
Second Line	:
City	:	NEVADA
State	:	MO
Zip	:	64772-3978
Country	:	US
Telephone Number	:	417-667-4322
Fax Number	:	417-667-8997

Provider Business Practice Location Address
First Line	:	202 S INDIANA ST
Second Line	:
City	:	NEVADA
State	:	MO
Zip	:	64772-3978
Country	:	US
Telephone Number	:	417-667-4322
Fax Number	:	417-667-8997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/18/2010

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