Healthcare Provider Details

I. General information

NPI: 1114226560
Provider Name (Legal Business Name): KIM EVANS BRUNO DC, CCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHAMPION CIR
LOVELAND CO
80538-4982
US

IV. Provider business mailing address

1217 RIVERSIDE AVE
FORT COLLINS CO
80524-3218
US

V. Phone/Fax

Practice location:
  • Phone: 970-691-3694
  • Fax:
Mailing address:
  • Phone: 970-691-3694
  • Fax: 970-482-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number6183
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: