MEDICARE: DR. BRADLEY ROLAND WINTER 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	111N00000X	Chiropractor	4704	MN

General Provider Information

NPI Number	:	1487650800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY ROLAND WINTER D.C.

Provider Business Mailing Address
First Line	:	1535 1ST AVE E
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-1753
Country	:	US
Telephone Number	:	763-689-0462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 1ST AVE E
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-1753
Country	:	US
Telephone Number	:	763-689-0462
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/25/2019

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