MEDICARE: DR. KEMP BRADLEY KIRK I 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	CH8334	FL

General Provider Information

NPI Number	:	1144352410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEMP BRADLEY KIRK I D.C.

Provider Business Mailing Address
First Line	:	PO BOX 578
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-0578
Country	:	US
Telephone Number	:	386-439-9099
Fax Number	:	386-439-9091

Provider Business Practice Location Address
First Line	:	212 MOODY BLVD
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-3372
Country	:	US
Telephone Number	:	386-439-9099
Fax Number	:	386-439-9091

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	08/08/2011

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