MEDICARE: DR. MARCUS BRADLEY FAVORITE 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	3865	OK

General Provider Information

NPI Number	:	1982878781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS BRADLEY FAVORITE D.C.

Provider Business Mailing Address
First Line	:	14101 N MAY AVE STE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-5071
Country	:	US
Telephone Number	:	405-753-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	13205 GREEN HILL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8875
Country	:	US
Telephone Number	:	405-753-9793
Fax Number	:

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

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	11/16/2020

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