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NPI Code Detail

MEDICARE: BRADLEY J E CLOW D.C., P.A.

MEDICARE:   BRADLEY J E CLOW  D.C., P.A.
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
1111N00000XChiropractorCH4422FL

General Provider Information

NPI Number : 1174589915
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY J E CLOW D.C., P.A.
Provider Business Mailing Address
First Line : 145 PALM BAY RD NE
Second Line : SUITE 120
City : WEST MELBOURNE
State : FL
Zip : 32904-8601
Country : US
Telephone Number : 321-725-8778
Fax Number : 321-984-5299
Provider Business Practice Location Address
First Line : 145 PALM BAY RD NE
Second Line : SUITE 120
City : WEST MELBOURNE
State : FL
Zip : 32904-8601
Country : US
Telephone Number : 321-725-8778
Fax Number : 321-984-5299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2006
Last Update Date : 08/23/2024

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