Blake Bredeson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6210-12 Issued in WI

Practice address

210 E Reed Ave
Manitowoc, WI 54220-2121

Phone

(920) 682-1111

NPI assigned

May 10, 2023

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maritime Chiropractic LLCGroup PAC ID 0648639856, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Maritime Chiropractic LLC

  • Chiropractor
  • Manitowoc, WI
  • NPI 1891490496
  Medicare reassignment Care Compare group NPD
• Linzmeier Chiropractic S C

  • Chiropractor
  • Manitowoc, WI
  • NPI 1356644033
  NPD

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1932899150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E REED AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202121",
            "telephone_number": "920-682-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E REED AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202121",
            "telephone_number": "920-682-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREDESON",
        "first_name": "BLAKE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-10",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "6210-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maren Bourelle
• Derek R Bown, DC
• Hailey Elizabeth Boyer, SLP
• Carrie L. Brazzale, D.C.
• Elisabeth Breaker, LAT, ATC, PES
• Emilie Brienen, M.S. CCC-SLP
• Heather Marie Bruckschen, LPC, CSAC
• Brittany Nicole Bryan
• Abbey Bubolz, RD
• Victoria Bubolz

• Chiropractor in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.