MEDICARE: MR. SHAWN BRADLEY D.C.

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	2004018211	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00453018	OTHER	MO	MEDICARE RAILROAD PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	192583	OTHER	MO	BCBS PROVIDER NUMBER
3	2247716	OTHER	MO	FIRST HEALTH PROVIDER #
4	686170	OTHER	MO	HEALTHLINK PROVIDER #
5	228713	OTHER	MO	GHP PIN

General Provider Information

NPI Number	:	1871605808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN BRADLEY D.C.

Provider Business Mailing Address
First Line	:	1761 JEFFCO BLVD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2713
Country	:	US
Telephone Number	:	636-296-1222
Fax Number	:	636-296-1226

Provider Business Practice Location Address
First Line	:	1761 JEFFCO BLVD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2713
Country	:	US
Telephone Number	:	636-296-1222
Fax Number	:	636-296-1226

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/14/2008

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Directions to “ MR. SHAWN BRADLEY D.C.” Practice Location

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