MEDICARE: MICHAEL BRADLEY SHINDER DC

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	2411	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	60629SH	OTHER	MN	BC/BS

General Provider Information

NPI Number	:	1336149095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BRADLEY SHINDER DC

Provider Business Mailing Address
First Line	:	4455 N HWY 169
Second Line	:	SUITE 200
City	:	PLYMOUTH
State	:	MN
Zip	:	55442
Country	:	US
Telephone Number	:	763-557-9032
Fax Number	:	763-557-9838

Provider Business Practice Location Address
First Line	:	4455 N HWY 169
Second Line	:	SUITE 200
City	:	PLYMOUTH
State	:	MN
Zip	:	55442
Country	:	US
Telephone Number	:	763-557-9032
Fax Number	:	763-557-9838

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	04/29/2010

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Directions to “ MICHAEL BRADLEY SHINDER DC” Practice Location

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