Provider Demographics
NPI:1568689537
Name:BRADSHAW RUTLEDGE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BRADSHAW RUTLEDGE CHIROPRACTIC INC.
Other - Org Name:DECOMPRESSION & COLD LASER CENTER OF SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-270-8111
Mailing Address - Street 1:2727 CAMINO DEL RIO S STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3739
Mailing Address - Country:US
Mailing Address - Phone:619-270-8111
Mailing Address - Fax:619-683-3188
Practice Address - Street 1:2727 CAMINO DEL RIO S STE 140
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3739
Practice Address - Country:US
Practice Address - Phone:619-270-8111
Practice Address - Fax:619-683-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty