MEDICARE: BRADLEY BACKHAUS DC LLC

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	261QH0100X	Health Service Clinic/Center	038.012607	IL

General Provider Information

NPI Number	:	1447661590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY BACKHAUS DC LLC

Provider Business Mailing Address
First Line	:	3019 N. LINCOLN AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-208-1550
Fax Number	:	312-284-8869

Provider Business Practice Location Address
First Line	:	3019 N. LINCOLN AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-208-1550
Fax Number	:	312-284-8869

Authorized Official
Title or Position	:	PHYSICIAN, OWNER
Name	:	DR. BRADLEY A BACKHAUS
Credential	:	D.C.
Telephone Number	:	312-208-1550

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	06/03/2026

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