Provider Demographics
NPI:1790701845
Name:SCHMIDT, BRADLEY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:SCHMIDT
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 1:1609 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5532
Mailing Address - Country:US
Mailing Address - Phone:408-448-8818
Mailing Address - Fax:408-448-8815
Practice Address - Street 1:1609 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5532
Practice Address - Country:US
Practice Address - Phone:408-448-8818
Practice Address - Fax:408-448-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04360Medicare UPIN