MEDICARE: BRADLEY DONALD KAASA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3216	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OA3358	OTHER	WA	REGENCE BLUE SHIELD
2	117064	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1447349592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY DONALD KAASA DC

Provider Business Mailing Address
First Line	:	PO BOX 911
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045
Country	:	US
Telephone Number	:	425-831-2331
Fax Number	:	425-831-2244

Provider Business Practice Location Address
First Line	:	325 E 3RD ST
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8250
Country	:	US
Telephone Number	:	425-831-2331
Fax Number	:	866-462-2960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/22/2020

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