Provider Demographics
NPI:1043279243
Name:HAUGO, BRADLEY JAY (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAY
Last Name:HAUGO
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 1:10 N O CONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56087-1308
Mailing Address - Country:US
Mailing Address - Phone:507-723-5515
Mailing Address - Fax:507-723-5515
Practice Address - Street 1:10 N O CONNELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MN
Practice Address - Zip Code:56087-1308
Practice Address - Country:US
Practice Address - Phone:507-723-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN911028300Medicaid
MN5C248HAOtherBCBS
MNT65601Medicare UPIN
MN911028300Medicaid