Provider Demographics
NPI:1194809319
Name:FINK, BRUCE MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:FINK
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 1:301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-1312
Mailing Address - Country:US
Mailing Address - Phone:814-274-8486
Mailing Address - Fax:814-274-7495
Practice Address - Street 1:301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-1312
Practice Address - Country:US
Practice Address - Phone:814-274-8486
Practice Address - Fax:814-274-7495
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002871L111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFI453644OtherHIGHMARK BLUE CROSS/BLUE
PAT25876Medicare UPIN
PAFI453644OtherHIGHMARK BLUE CROSS/BLUE