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NPI Code Detail

MEDICARE: DR. BRAD JOHN MCNULTY DC

MEDICARE:  DR. BRAD JOHN MCNULTY  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
1111N00000XChiropractorCHIR005076GA

General Provider Information

NPI Number : 1578616587
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRAD JOHN MCNULTY DC
Provider Business Mailing Address
First Line : 4114 MILL ST NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2539
Country : US
Telephone Number : 770-787-6113
Fax Number : 770-787-8287
Provider Business Practice Location Address
First Line : 4114 MILL ST NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2539
Country : US
Telephone Number : 770-787-6113
Fax Number : 770-787-8287
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2007
Last Update Date : 07/09/2007

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Directions to “ DR. BRAD JOHN MCNULTY DC” Practice Location

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