Provider Demographics
NPI:1982916391
Name:TEPPER, BRAD D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:D
Last Name:TEPPER
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 1:1721 RIDGEWOOD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5405
Mailing Address - Country:US
Mailing Address - Phone:386-310-7246
Mailing Address - Fax:386-310-4952
Practice Address - Street 1:800 STERTHAUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5132
Practice Address - Country:US
Practice Address - Phone:386-310-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2209YOtherBCBS
FLFC954ZMedicare PIN