Provider Demographics
NPI:1699160895
Name:BRADLEY, JEROD (DC)
Entity type:Individual
Prefix:DR
First Name:JEROD
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25900 GREENFIELD RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1292
Mailing Address - Country:US
Mailing Address - Phone:248-352-5851
Mailing Address - Fax:248-569-5590
Practice Address - Street 1:1341 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6257
Practice Address - Country:US
Practice Address - Phone:989-486-3004
Practice Address - Fax:989-486-3033
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor