MEDICARE: BRIDEGET N URBAN DC LLC

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	2215	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730689837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDEGET N URBAN DC LLC

Provider Business Mailing Address
First Line	:	3958 HARBOR LIGHT LANDING
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-3876
Country	:	US
Telephone Number	:	330-360-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3958 HARBOR LIGHT LANDING
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-3876
Country	:	US
Telephone Number	:	330-360-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIDGETT NOEL URBAN
Credential	:	DC
Telephone Number	:	330-360-2225

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	02/20/2018

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Directions to “BRIDEGET N URBAN DC LLC ” Practice Location

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