Individual provider Active NPI

Bradley J E Clow, D.C., P.A.

  • Chiropractor
  • West Melbourne, FL
National Provider Identifier
1174589915
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH4422 Issued in FL
Practice address
145 Palm Bay Rd NE
Suite 120
West Melbourne, FL 32904-8601
Phone
(321) 725-8778
Fax
(321) 984-5299
NPI assigned
Apr 21, 2006
Last updated
Aug 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH4422 FL Primary

Addresses

Primary practice location

145 Palm Bay Rd NE
Suite 120
West Melbourne, FL 32904-8601

Mailing address

145 Palm Bay Rd NE
Suite 120
West Melbourne, FL 32904-8601
Phone (321) 725-8778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080807000185 FL Practitioner - Chiropractic 2163596206 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Space Coast Corporate Health Service P aGroup PAC ID 5799859831, 3 clinicians
Clow Integrated Medical Center PAGroup PAC ID 8820529118, 4 clinicians
Bradley J E Clow D C P aGroup PAC ID 0941361786, 3 clinicians

Practice addresses (Care Compare)

145 Palm Bay Nerd
Suite 120
West Melbourne, FL 32904-8601
Phone (321) 725-8778

145 Palm Bay Rd NE
Suite 120
West Melbourne, FL 32904-8601
Phone (321) 725-8778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clow Integrated Medical Center PA CurrentSince Jun 1, 2024 Accepting new patients
Space Coast Corporate Health Service P a Chiropractor CurrentSince May 6, 2008 Accepting new patients
Bradley J E Clow D C P a Chiropractor CurrentSince May 6, 2008 Accepting new patients

Locations

145 Palm Bay Rd NE
Ste 120
West Melbourne, FL 32904
Phone (321) 725-8778

145 Palm Bay Rd NE
Ste 121
West Melbourne, FL 32904
Phone (321) 725-8778

Interoperability endpoints

  • Direct secure messaging: dc1@dbjc0001.direct.chirotouch.md

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1174589915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 PALM BAY RD NE",
            "address_2": "SUITE 120",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329048601",
            "telephone_number": "321-725-8778",
            "fax_number": "321-984-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 PALM BAY RD NE",
            "address_2": "SUITE 120",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329048601",
            "telephone_number": "321-725-8778",
            "fax_number": "321-984-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOW",
        "first_name": "BRADLEY",
        "middle_name": "J E",
        "credential": "D.C., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH4422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.