Provider Demographics
NPI:1689971277
Name:VERBURG, BRADLEY RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RICHARD
Last Name:VERBURG
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 1:4500 S HAGADORN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6813
Mailing Address - Country:US
Mailing Address - Phone:517-324-5433
Mailing Address - Fax:517-324-9594
Practice Address - Street 1:4500 S HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6813
Practice Address - Country:US
Practice Address - Phone:517-324-5433
Practice Address - Fax:517-324-9594
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor