Provider Demographics
NPI:1215218524
Name:SABO, BRADLEY ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ADAM
Last Name:SABO
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 1:25 S LAPEER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3182
Mailing Address - Country:US
Mailing Address - Phone:248-693-4800
Mailing Address - Fax:248-693-3539
Practice Address - Street 1:25 S LAPEER ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3182
Practice Address - Country:US
Practice Address - Phone:248-693-4800
Practice Address - Fax:248-693-3539
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor