Basic Information
Provider Information
NPI: 1003147141
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: METZLER
FirstName: BRADLEY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 129 FILLMORE ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941173555
CountryCode: US
TelephoneNumber: 4156890912
FaxNumber:  
Practice Location
Address1: 129 FILLMORE ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941173555
CountryCode: US
TelephoneNumber: 4156890912
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/28/2010
LastUpdateDate: 10/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X32223CAY Chiropractic ProvidersChiropractor 
111N00000X1609NEN Chiropractic ProvidersChiropractor 

No ID Information.


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