Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2133-012 | WI |
N | 111NN1001X | Nutrition | 2133-012 | WI |
N | 111NR0200X | Radiology | 2133-012 | WI |
N | 213ER0200X | Radiology | 2133-012 | WI |
NPI | 1194856070 |
---|---|
Provider Name | Dr. Edward Victor Braun |
First Address | Belgium, WI 53004-0225 |
Second Address | Belgium, WI 53004-0225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |