Provider Demographics
NPI:1588322531
Name:BRUENGER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BRUENGER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BRUENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-837-1466
Mailing Address - Street 1:1526 WEST JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-837-1466
Mailing Address - Fax:309-837-1163
Practice Address - Street 1:1526 WEST JACKSON STREET
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-837-1466
Practice Address - Fax:309-837-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty