Healthcare Provider Details

I. General information

NPI: 1447349592
Provider Name (Legal Business Name): BRADLEY DONALD KAASA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 3RD ST
NORTH BEND WA
98045-8250
US

IV. Provider business mailing address

PO BOX 911
NORTH BEND WA
98045
US

V. Phone/Fax

Practice location:
  • Phone: 425-831-2331
  • Fax: 866-462-2960
Mailing address:
  • Phone: 425-831-2331
  • Fax: 425-831-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: