Healthcare Provider Details

I. General information

NPI: 1386370583
Provider Name (Legal Business Name): BRUNO PAIN & PERFORMANCE SOLUTIONS LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST STE 240
KIRKWOOD MO
63122-7360
US

IV. Provider business mailing address

1099 MILWAUKEE ST STE 240
KIRKWOOD MO
63122-7360
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ROSARIO R BRUNO
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 813-226-7230