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General NPI Number Information
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NPI Number | 1689971277
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Entity Type | Individual
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Provider Name | BRADLEY RICHARD VERBURG D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 4500 S HAGADORN RD
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City | EAST LANSING
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State | MI
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Zip | 48823-6813
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Country | US
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Telephone | 517-324-5433
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Fax | 517-324-9594
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Provider Business Mailing Address
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Address Line | 4500 S HAGADORN RD
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City | EAST LANSING
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State | MI
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Zip | 48823-6813
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Country | US
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Telephone | 517-324-5433
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Fax | 517-324-9594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009779
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License Number State | MI
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