Provider Demographics
NPI:1972601557
Name:VEAL, BRAD N (DC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:N
Last Name:VEAL
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 1:1260 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-2069
Mailing Address - Country:US
Mailing Address - Phone:715-748-6969
Mailing Address - Fax:
Practice Address - Street 1:1260 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-2069
Practice Address - Country:US
Practice Address - Phone:715-748-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3326-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350037849OtherRAILROAD MEDICARE
CB3715OtherRAILROAD MEDICARE
WI38895500Medicaid
43650OtherSECURITY HEALTH PLAN
38988000OtherMEDICAID GROUP
WI000370240Medicare ID - Type Unspecified
U61715Medicare UPIN