Provider Demographics
NPI:1487647723
Name:BRAMSTEDT, JASON C (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:BRAMSTEDT
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 1:2222 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3709
Mailing Address - Country:US
Mailing Address - Phone:715-395-5393
Mailing Address - Fax:218-624-6097
Practice Address - Street 1:2222 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3709
Practice Address - Country:US
Practice Address - Phone:715-392-1955
Practice Address - Fax:715-392-1935
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3800111N00000X
WI5773-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61G99BROtherBLUE CROSS BLUE SHIELD
MN941828800Medicaid
MN2192561OtherFIRST HEALTH
MN606827OtherCHIROCARE
MN350046859Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MNU77123Medicare UPIN
MN61G99BROtherBLUE CROSS BLUE SHIELD