Provider Demographics
NPI:1780711606
Name:SEVERSON, WILLIAM BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:SEVERSON
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 1:2150 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:#5
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7045
Mailing Address - Country:US
Mailing Address - Phone:760-324-3131
Mailing Address - Fax:760-325-1818
Practice Address - Street 1:2150 E TAHQUITZ CANYON WAY
Practice Address - Street 2:#5
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7045
Practice Address - Country:US
Practice Address - Phone:760-324-3131
Practice Address - Fax:760-325-1818
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07602Medicare ID - Type Unspecified