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General NPI Number Information
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NPI Number | 1699160895
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Entity Type | Individual
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Provider Name | JEROD BRADLEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 1341 N JOHNSON ST
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City | BAY CITY
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State | MI
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Zip | 48708-6257
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Country | US
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Telephone | 989-486-3004
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Fax | 989-486-3033
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Provider Business Mailing Address
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Address Line | 25900 GREENFIELD RD SUITE 140
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City | OAK PARK
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State | MI
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Zip | 48237-1292
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Country | US
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Telephone | 248-352-5851
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Fax | 248-569-5590
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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 | 2301010315
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License Number State | MI
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