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General NPI Number Information
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NPI Number | 1811397136
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Entity Type | Organization
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Legal Business Name | GENERATIONS CHIROPRACTIC WELLNESS, LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 8115 FRUIT FARM RD
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City | BELVIDERE
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State | IL
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Zip | 61008-9075
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Country | US
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Telephone | 815-547-6333
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Fax | 815-642-5695
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Provider Business Mailing Address
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Address Line | 8115 FRUIT FARM RD
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City | BELVIDERE
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State | IL
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Zip | 61008-9075
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Country | US
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Telephone | 815-547-6333
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Fax | 815-642-5695
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | DR. SAMANTHA ELIZABETH BRADLEY
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Credential | DC
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Telephone | 815-547-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038012666
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License Number State | IL
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