Provider Demographics
NPI:1083722920
Name:PAULSON, BRADLEY ALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALVIN
Last Name:PAULSON
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005
Mailing Address - Country:US
Mailing Address - Phone:715-263-2313
Mailing Address - Fax:715-263-3284
Practice Address - Street 1:336 3RD AVE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:WI
Practice Address - Zip Code:54005
Practice Address - Country:US
Practice Address - Phone:715-263-2313
Practice Address - Fax:715-263-3284
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38789400Medicaid
WI38789400Medicaid