Provider Demographics
NPI:1447349592
Name:KAASA, BRADLEY DONALD (DC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DONALD
Last Name:KAASA
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:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045
Mailing Address - Country:US
Mailing Address - Phone:425-831-2331
Mailing Address - Fax:425-831-2244
Practice Address - Street 1:325 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8250
Practice Address - Country:US
Practice Address - Phone:425-831-2331
Practice Address - Fax:866-462-2960
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOA3358OtherREGENCE BLUE SHIELD
WA117064OtherLABOR & INDUSTRIES
WAOA3358OtherREGENCE BLUE SHIELD
WAGAB02376Medicare ID - Type Unspecified