MEDICARE: DR. BRAD ELDRIDGE 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	1815	TN

General Provider Information

NPI Number	:	1518046788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD ELDRIDGE D.C.

Provider Business Mailing Address
First Line	:	908 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4116
Country	:	US
Telephone Number	:	423-232-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4116
Country	:	US
Telephone Number	:	423-232-9600
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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