Provider Demographics
NPI:1174515639
Name:PAULSON, KENDALL RAY (DC)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:RAY
Last Name:PAULSON
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 1:3292 N M 33
Mailing Address - Street 2:P O BOX 27
Mailing Address - City:ROSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48654-9416
Mailing Address - Country:US
Mailing Address - Phone:989-685-2631
Mailing Address - Fax:989-685-3839
Practice Address - Street 1:3292 N M 33
Practice Address - Street 2:
Practice Address - City:ROSE CITY
Practice Address - State:MI
Practice Address - Zip Code:48654-9416
Practice Address - Country:US
Practice Address - Phone:989-685-2631
Practice Address - Fax:989-685-3839
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F550270OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0F55027Medicare ID - Type Unspecified