Bradley Douglas Lidvall, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

101934 Issued in IA

Practice address

2220 E 53Rd St
Davenport, IA 52807-2704

Phone

(480) 200-2983

NPI assigned

Sep 17, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pearl City Chiropractic LLCGroup PAC ID 0345637369, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pearl City Chiropractic LLC

  • Chiropractor
  • Muscatine, IA
  • NPI 1326788175
  Medicare reassignment Care Compare group NPD
• Quad City Wellness Group, LLC

  • Chiropractor
  • Davenport, IA
  • NPI 1982135976
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1033725866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28010 238TH ST",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527539126",
            "telephone_number": "480-200-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 E 53RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072704",
            "telephone_number": "480-200-2983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDVALL",
        "first_name": "BRADLEY",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "101934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Lee Schauer Leveridge, MD
• Mark J Levsen, P.T.
• Melissa Ann Lewellen, PT
• John Randolph Lewis, M.D.
• Zachary Lewis, D.O.
• Kayla Lietz
• Life Labyrinth Psychotherapy
• Lifetime Eyehealth Associates PC
• Lifetime Family Chiropractic
• Andrew J Lightfoot, MD

• Chiropractor in Davenport, IA
• Providers in Davenport, IA by specialty
• Chiropractor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.