MEDICARE: DAVID B. BRADLEY, DC, PC

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	4202	TX

General Provider Information

NPI Number	:	1578706149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B. BRADLEY, DC, PC

Provider Business Mailing Address
First Line	:	729 W. BEDFORD-EULESS RD
Second Line	:	STE 209
City	:	HURST
State	:	TX
Zip	:	76053-3941
Country	:	US
Telephone Number	:	817-282-7600
Fax Number	:	817-282-7604

Provider Business Practice Location Address
First Line	:	729 W. BEDFORD-EULESS RD
Second Line	:	STE 209
City	:	HURST
State	:	TX
Zip	:	76053-3941
Country	:	US
Telephone Number	:	817-282-7600
Fax Number	:	817-282-7604

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. DAVID B BRADLEY
Credential	:	D.C.
Telephone Number	:	817-282-7600

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	09/18/2009

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