MEDICARE: BRADSHAW RUTLEDGE CHIROPRACTIC INC.

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	DC27360	CA

General Provider Information

NPI Number	:	1568689537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADSHAW RUTLEDGE CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	2727 CAMINO DEL RIO S STE 140
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3739
Country	:	US
Telephone Number	:	619-270-8111
Fax Number	:	619-683-3188

Provider Business Practice Location Address
First Line	:	2727 CAMINO DEL RIO S STE 140
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3739
Country	:	US
Telephone Number	:	619-270-8111
Fax Number	:	619-683-3188

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. HILARY JOYCE RUTLEDGE
Credential	:	DC
Telephone Number	:	619-270-8111

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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