Healthcare Provider Details

I. General information

NPI: 1699160895
Provider Name (Legal Business Name): JEROD BRADLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N JOHNSON ST
BAY CITY MI
48708-6257
US

IV. Provider business mailing address

25900 GREENFIELD RD SUITE 140
OAK PARK MI
48237-1292
US

V. Phone/Fax

Practice location:
  • Phone: 989-486-3004
  • Fax: 989-486-3033
Mailing address:
  • Phone: 248-352-5851
  • Fax: 248-569-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010315
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: