Healthcare Provider Details

I. General information

NPI: 1437741220
Provider Name (Legal Business Name): BRADLEY ADAM FITZGERALD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EL CAJON BLVD
SAN DIEGO CA
92104-1105
US

IV. Provider business mailing address

2301 EL CAJON BLVD
SAN DIEGO CA
92104-1105
US

V. Phone/Fax

Practice location:
  • Phone: 619-269-9909
  • Fax:
Mailing address:
  • Phone: 619-269-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number34568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: