Provider Demographics
NPI:1588060115
Name:BRUENING, BRANDON (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BRUENING
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 1:1210 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2233
Mailing Address - Country:US
Mailing Address - Phone:217-223-6170
Mailing Address - Fax:217-223-6177
Practice Address - Street 1:1210 N 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2233
Practice Address - Country:US
Practice Address - Phone:217-223-6170
Practice Address - Fax:217-223-6177
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor