Provider Demographics
NPI:1396795894
Name:PAULSON, JERRY ARNOLD (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ARNOLD
Last Name:PAULSON
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 1:7392 E COZY CAMP DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1957
Mailing Address - Country:US
Mailing Address - Phone:928-772-3719
Mailing Address - Fax:
Practice Address - Street 1:7392 E COZY CAMP DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1957
Practice Address - Country:US
Practice Address - Phone:928-772-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938390OtherBLUE CROSS
AZZ64461Medicare ID - Type Unspecified