MEDICARE: DR. CRAIG W. BRUE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4057	AZ

General Provider Information

NPI Number	:	1942393715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG W. BRUE D.C.

Provider Business Mailing Address
First Line	:	164 E RIDGE GLOW PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737-7973
Country	:	US
Telephone Number	:	520-531-1353
Fax Number	:	520-575-7114

Provider Business Practice Location Address
First Line	:	63701 E SADDLEBROOKE BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-1273
Country	:	US
Telephone Number	:	520-825-8182
Fax Number	:	520-825-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/02/2012

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