MEDICARE: BRAD NELSON 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
1	111N00000X	Chiropractor	CH10252	FL

General Provider Information

NPI Number	:	1770871659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD NELSON DC

Provider Business Mailing Address
First Line	:	6300 N WICKHAM RD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32940-2028
Country	:	US
Telephone Number	:	321-253-2169
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 S WICKHAM RD
Second Line	:	SUITE 2
City	:	MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-951-4144
Fax Number	:

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

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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Directions to “ BRAD NELSON DC” Practice Location

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