MEDICARE: BRADLEY A DAVIS 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	CE006537	MO

General Provider Information

NPI Number	:	1154427300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY A DAVIS D.C.

Provider Business Mailing Address
First Line	:	416 HARRINGTON PL
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-7706
Country	:	US
Telephone Number	:	636-294-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 MEXICO RD
Second Line	:	STE 20
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1696
Country	:	US
Telephone Number	:	636-936-1100
Fax Number	:	636-936-1655

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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