Provider Demographics
NPI:1134983489
Name:PAULSEN, BRENNAN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:THOMAS
Last Name:PAULSEN
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 1:4205 LANCASTER LN N STE 105
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1702
Mailing Address - Country:US
Mailing Address - Phone:763-536-1112
Mailing Address - Fax:763-536-0471
Practice Address - Street 1:4205 LANCASTER LN N STE 105
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1702
Practice Address - Country:US
Practice Address - Phone:763-536-1112
Practice Address - Fax:763-536-0471
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor