Healthcare Provider Details

I. General information

NPI: 1598845372
Provider Name (Legal Business Name): JUDYTH A. BRUNO D. C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20312 STATE HIGHWAY M28 STE A
EWEN MI
49925-8001
US

IV. Provider business mailing address

9381 LOOP RD
TROUT CREEK MI
49967-9393
US

V. Phone/Fax

Practice location:
  • Phone: 488-988-2080
  • Fax: 906-988-2080
Mailing address:
  • Phone: 906-852-3290
  • Fax: 906-852-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005866
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: