Provider Demographics
NPI:1801888342
Name:THOMSEN, BRADLEY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:THOMSEN
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:PO BOX 12875
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208-2875
Mailing Address - Country:US
Mailing Address - Phone:701-746-8636
Mailing Address - Fax:701-746-8827
Practice Address - Street 1:2534 17TH AVE S
Practice Address - Street 2:SUITE 2D
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5215
Practice Address - Country:US
Practice Address - Phone:701-746-8636
Practice Address - Fax:701-746-8827
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10583Medicaid
ND17929Medicare PIN
NDU69591Medicare UPIN