Provider Demographics
NPI:1598774556
Name:YAEGER, BRADFORD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:JAMES
Last Name:YAEGER
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 1:1615 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5675Medicare ID - Type Unspecified