Provider Demographics
NPI:1578835914
Name:BRADFORD J. YAEGER, P.A.
Entity Type:Organization
Organization Name:BRADFORD J. YAEGER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-275-6545
Mailing Address - Street 1:1615 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1101
Mailing Address - Country:US
Mailing Address - Phone:239-275-6545
Mailing Address - Fax:239-275-6558
Practice Address - Street 1:1615 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1101
Practice Address - Country:US
Practice Address - Phone:239-275-6545
Practice Address - Fax:239-275-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5675Medicare PIN
FLU854990001Medicare UPIN