Provider Demographics
NPI:1316009681
Name:DR BRAD HAUGO DC CHTD
Entity Type:Organization
Organization Name:DR BRAD HAUGO DC CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HAUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-723-5515
Mailing Address - Street 1:10 N O CONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56087-1308
Mailing Address - Country:US
Mailing Address - Phone:507-723-5515
Mailing Address - Fax:507-723-5515
Practice Address - Street 1:10 N O CONNELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MN
Practice Address - Zip Code:56087-1308
Practice Address - Country:US
Practice Address - Phone:507-723-5515
Practice Address - Fax:507-723-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C247HAOtherBCBS OFFICE