MEDICARE: DR. TODD MICHAEL BRAGG 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	DC24944	CA

General Provider Information

NPI Number	:	1922153360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD MICHAEL BRAGG D.C.

Provider Business Mailing Address
First Line	:	100 OCONNOR DR
Second Line	:	SUITE 28
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1647
Country	:	US
Telephone Number	:	408-977-0975
Fax Number	:	408-977-1068

Provider Business Practice Location Address
First Line	:	100 OCONNOR DR
Second Line	:	SUITE 28
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1647
Country	:	US
Telephone Number	:	408-977-0975
Fax Number	:	408-977-1068

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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