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NPI Code Detail

MEDICARE: DR. BRADLEY B POWELL DC

MEDICARE: DR. BRADLEY B POWELL 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
1111N00000XChiropractorDC27515CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DC0275150OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1992709927
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY B POWELL DC
Provider Business Mailing Address
First Line : 24582 DEL PRADO
Second Line : STE H
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Provider Business Practice Location Address
First Line : 24582 DEL PRADO
Second Line : STE H
City : DANA POINT
State : CA
Zip : 92629-3821
Country : US
Telephone Number : 949-487-2722
Fax Number : 949-487-2723
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 07/08/2007

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