MEDICARE: BRADFORD THOMAS KREMER 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	CH60071550	WA

General Provider Information

NPI Number	:	1063654853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD THOMAS KREMER D.C.

Provider Business Mailing Address
First Line	:	3901 NE 4TH ST
Second Line	:	STE 109
City	:	RENTON
State	:	WA
Zip	:	98056-4100
Country	:	US
Telephone Number	:	425-277-0577
Fax Number	:	425-277-0652

Provider Business Practice Location Address
First Line	:	3901 NE 4TH ST
Second Line	:	STE 109
City	:	RENTON
State	:	WA
Zip	:	98056-4100
Country	:	US
Telephone Number	:	425-277-0577
Fax Number	:	425-277-0652

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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