Brent Richard Paulson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4949-12 Issued in WI

Practice address

336 3Rd Ave
Clear Lake, WI 54005-8581

Phone

(715) 263-2313

Fax

(715) 263-3284

NPI assigned

Aug 2, 2013

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

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paulson Chiropractic Clinic, LLCGroup PAC ID 2769611508, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paulson Chiropractic Clinic, LLC

  • Chiropractor
  • Clear Lake, WI
  • NPI 1215364211
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1871925669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540050096",
            "telephone_number": "715-263-2313",
            "fax_number": "715-263-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 3RD AVE",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540058581",
            "telephone_number": "715-263-2313",
            "fax_number": "715-263-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "BRENT",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-02",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4949-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jolleen Mary Nichols, DNP
• Northern Roots Family Spinal Care, LLC
• Northland Audiology LLC
• Paulson Chiropractic Clinic, LLC
• Bradley Alvin Paulson, DC
• School District of Clear Lake
• Village of Clear Lake

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.