Provider Demographics
NPI:1922153360
Name:BRAGG, TODD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:BRAGG
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 1:100 OCONNOR DR
Mailing Address - Street 2:SUITE 28
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1647
Mailing Address - Country:US
Mailing Address - Phone:408-977-0975
Mailing Address - Fax:408-977-1068
Practice Address - Street 1:100 OCONNOR DR
Practice Address - Street 2:SUITE 28
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1647
Practice Address - Country:US
Practice Address - Phone:408-977-0975
Practice Address - Fax:408-977-1068
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0249440Medicare ID - Type Unspecified