Provider Demographics
NPI:1386039972
Name:BRUNS CHIROPRACTIC OFFICE LLC
Entity type:Organization
Organization Name:BRUNS CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-912-2563
Mailing Address - Street 1:1429 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4760
Mailing Address - Country:US
Mailing Address - Phone:920-912-2563
Mailing Address - Fax:
Practice Address - Street 1:1429 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4760
Practice Address - Country:US
Practice Address - Phone:920-912-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4088-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty