Provider Demographics
NPI:1487699724
Name:BIERBRAUER, PAUL CHRISTIAN (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHRISTIAN
Last Name:BIERBRAUER
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 1:221 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1216
Mailing Address - Country:US
Mailing Address - Phone:612-332-4414
Mailing Address - Fax:612-332-4244
Practice Address - Street 1:221 10TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1216
Practice Address - Country:US
Practice Address - Phone:612-332-4414
Practice Address - Fax:612-332-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3291-012111N00000X
MN4657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38890000Medicaid
WI38890000Medicaid