Healthcare Provider Details

I. General information

NPI: 1285736587
Provider Name (Legal Business Name): THOMAS GLENN BRUNO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20312 STATE HIGHWAY M28 SUITE A
EWEN MI
49925-9082
US

IV. Provider business mailing address

9381 LOOP RD
TROUT CREEK MI
49967-9393
US

V. Phone/Fax

Practice location:
  • Phone: 906-988-2080
  • Fax: 906-988-2080
Mailing address:
  • Phone: 906-988-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005867
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: