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NPI Code Detail

MEDICARE: BRADLEY GARTH FORTUNE D.C.

MEDICARE:   BRADLEY GARTH FORTUNE  D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor8609TX

General Provider Information

NPI Number : 1023106069
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY GARTH FORTUNE D.C.
Provider Business Mailing Address
First Line : 4204 AUSTIN AVE
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-6822
Country : US
Telephone Number : 325-641-8800
Fax Number :
Provider Business Practice Location Address
First Line : 4204 AUSTIN AVE
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-6822
Country : US
Telephone Number : 325-641-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/08/2007

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Directions to “ BRADLEY GARTH FORTUNE D.C.” Practice Location

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