Provider Demographics
NPI:1053345330
Name:PAULSON, BRIAN R (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:PAULSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 WILLMAR AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4765
Mailing Address - Country:US
Mailing Address - Phone:320-235-6320
Mailing Address - Fax:320-235-2542
Practice Address - Street 1:1550 WILLMAR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4765
Practice Address - Country:US
Practice Address - Phone:320-235-6320
Practice Address - Fax:320-235-2542
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2904047-00Medicaid
MN2904047-00Medicaid