Provider Demographics
NPI:1467566901
Name:KUEHL, BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:KUEHL
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 1:922 125TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3182
Mailing Address - Country:US
Mailing Address - Phone:763-755-0100
Mailing Address - Fax:763-755-1809
Practice Address - Street 1:922 125TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3182
Practice Address - Country:US
Practice Address - Phone:763-755-0100
Practice Address - Fax:763-755-1809
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35003621Medicare ID - Type Unspecified