Healthcare Provider Details

I. General information

NPI: 1720626062
Provider Name (Legal Business Name): KEVIN A BRUINSMA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1678 W CHESTNUT AVE
VINELAND NJ
08360-4365
US

IV. Provider business mailing address

1720 10TH AVE S UNIT 296
GREAT FALLS MT
59405-2636
US

V. Phone/Fax

Practice location:
  • Phone: 856-265-7196
  • Fax:
Mailing address:
  • Phone: 406-216-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00811300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: