Provider Demographics
NPI:1285696302
Name:BREDAEL, WILLIAM JOSEPH (BS, DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BREDAEL
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 CENTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-8395
Mailing Address - Country:US
Mailing Address - Phone:920-845-5569
Mailing Address - Fax:920-845-5568
Practice Address - Street 1:195 CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-8395
Practice Address - Country:US
Practice Address - Phone:920-845-5569
Practice Address - Fax:920-845-5568
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4087-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38957600Medicaid
WI38957600Medicaid
WIV03290Medicare UPIN