Provider Demographics
NPI:1285736587
Name:BRUNO, THOMAS GLENN (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GLENN
Last Name:BRUNO
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 1:9381 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49967-9393
Mailing Address - Country:US
Mailing Address - Phone:906-988-2080
Mailing Address - Fax:
Practice Address - Street 1:20312 STATE HIGHWAY M28
Practice Address - Street 2:SUITE A
Practice Address - City:EWEN
Practice Address - State:MI
Practice Address - Zip Code:49925-9082
Practice Address - Country:US
Practice Address - Phone:906-988-2080
Practice Address - Fax:906-988-2080
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00126212OtherRAILROAD MEDICARE
MI950F650030OtherBCBSM
MI950F650030OtherBCBSM