Provider Demographics
NPI:1427120013
Name:BRUNET, IAN BRADLEY (DC, BCAO)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:BRADLEY
Last Name:BRUNET
Suffix:
Gender:M
Credentials:DC, BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 HWY 314
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1385
Mailing Address - Country:US
Mailing Address - Phone:678-817-4053
Mailing Address - Fax:678-817-4058
Practice Address - Street 1:288 HWY 314
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1385
Practice Address - Country:US
Practice Address - Phone:678-817-4053
Practice Address - Fax:678-817-4058
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor