Provider Demographics
NPI:1194856070
Name:BRAUN, EDWARD VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VICTOR
Last Name:BRAUN
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 225
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-0225
Mailing Address - Country:US
Mailing Address - Phone:262-285-3881
Mailing Address - Fax:262-285-3881
Practice Address - Street 1:604 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELGIUM
Practice Address - State:WI
Practice Address - Zip Code:53004-0225
Practice Address - Country:US
Practice Address - Phone:262-285-3881
Practice Address - Fax:262-285-3881
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2133-012111NN1001X, 111NR0200X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065894Medicaid
WI39-1584331OtherEMPLOYER IDETIFICATION NU