Provider Demographics
NPI:1457097537
Name:QUANTUM CHIROPRACTIC AND MASSAGE PLLC
Entity Type:Organization
Organization Name:QUANTUM CHIROPRACTIC AND MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-556-1060
Mailing Address - Street 1:2922 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3418
Mailing Address - Country:US
Mailing Address - Phone:586-556-1060
Mailing Address - Fax:
Practice Address - Street 1:1320 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1555
Practice Address - Country:US
Practice Address - Phone:248-733-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty