Healthcare Provider Details

I. General information

NPI: 1881761237
Provider Name (Legal Business Name): BRUCE E NORDSTROM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 K ST NW SUITE 100
WASHINGTON DC
20006-2806
US

IV. Provider business mailing address

9117 SCOTT ST
SPRINGFIELD VA
22153-4110
US

V. Phone/Fax

Practice location:
  • Phone: 202-466-3803
  • Fax: 202-429-9699
Mailing address:
  • Phone: 703-440-0072
  • Fax: 202-429-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH14048
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: