Individual
MR. BRADLEY ALLEN KOTHLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
314 MAIN ST, BALSAM LAKE, WI 54810-7262
(715) 485-3575
Mailing address
138 PLEASANT AVE, BALSAM LAKE, WI 54810-9019
(715) 485-9352
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2016012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38789500
—
WI
Enumeration date
10/26/2006
Last updated
07/08/2007
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