MEDICARE: DR. BRADLEY JAY ROBBINS 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
1	111N00000X	Chiropractor	1392	LA

General Provider Information

NPI Number	:	1033171780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY JAY ROBBINS D.C

Provider Business Mailing Address
First Line	:	13375 HIGHWAY 73 STE C
Second Line	:
City	:	GEISMAR
State	:	LA
Zip	:	70734-3057
Country	:	US
Telephone Number	:	225-677-5159
Fax Number	:	225-673-4158

Provider Business Practice Location Address
First Line	:	13375 HIGHWAY 73
Second Line	:
City	:	GEISMAR
State	:	LA
Zip	:	70734-3000
Country	:	US
Telephone Number	:	225-677-5159
Fax Number	:	225-673-4158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/03/2008

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