MEDICARE: DR. BRADLEY R HENNEN 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	2926	CO

General Provider Information

NPI Number	:	1336183839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY R HENNEN DC

Provider Business Mailing Address
First Line	:	3510 GALLEY RD
Second Line	:	STE 104
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4312
Country	:	US
Telephone Number	:	719-380-0138
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 GALLEY RD
Second Line	:	STE 104
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4312
Country	:	US
Telephone Number	:	719-380-0138
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BRADLEY R HENNEN DC” Practice Location

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