Healthcare Provider Details

I. General information

NPI: 1538401724
Provider Name (Legal Business Name): KRISTEN BESSLER BRUSKY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. KRISTEN MARIE BRUSKY

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 5TH ST STE 200
LEBANON OR
97355-2875
US

IV. Provider business mailing address

675 N 5TH ST # 200
LEBANON OR
97355-2875
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO192463
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO192463
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: