Healthcare Provider Details

I. General information

NPI: 1104927268
Provider Name (Legal Business Name): CHAD J BURUD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HIGHWAY 75 N
BRECKENRIDGE MN
56520-1007
US

IV. Provider business mailing address

1325 HIGHWAY 75 N
BRECKENRIDGE MN
56520-1007
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-1668
  • Fax:
Mailing address:
  • Phone: 218-643-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3312
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number586
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: