Bradley Allen Kothlow, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2016012 Issued in WI

Practice address

314 Main St
Balsam Lake, WI 54810-7262

Phone

(715) 485-3575

NPI assigned

Oct 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1985

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447335609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 PLEASANT AVE",
            "city": "BALSAM LAKE",
            "state": "WI",
            "postal_code": "548109019",
            "telephone_number": "715-485-9352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MAIN ST",
            "city": "BALSAM LAKE",
            "state": "WI",
            "postal_code": "548107262",
            "telephone_number": "715-485-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHLOW",
        "first_name": "BRADLEY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2016012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38789500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Paul Erickson, R.PH.
• John Hale, LSW
• Kathleen M Herbison Kisting, CSAC
• Angela Joy, LSW
• Chad Knutson, BS BA
• Zoey L Larson, CNA
• Debra Ann Leschisin, RN-C
• Leah Loeffler
• Anita Lundquist, PHARMD
• Kathleen M McGurran, LSW

• Chiropractor in Balsam Lake, WI
• Providers in Balsam Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.