MEDICARE: DR. BRADLEY KEITH QUICK 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	111NX0800X	Orthopedic Chiropractor	DC15356	CA

General Provider Information

NPI Number	:	1093842692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY KEITH QUICK D.C.

Provider Business Mailing Address
First Line	:	10442 MONOGRAM AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6755
Country	:	US
Telephone Number	:	818-652-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	10442 MONOGRAM AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6755
Country	:	US
Telephone Number	:	818-652-5763
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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