MEDICARE: BRADLEY I MANDELL 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	3020	SC

General Provider Information

NPI Number	:	1194720458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY I MANDELL D.C.

Provider Business Mailing Address
First Line	:	3629 SUZANNE DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9318
Country	:	US
Telephone Number	:	843-957-0943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3629 SUZANNE DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9318
Country	:	US
Telephone Number	:	843-957-0943
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/19/2019

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