Healthcare Provider Details

I. General information

NPI: 1740266808
Provider Name (Legal Business Name): VINCENT EDWARD BRUNELLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W MAIN ST
WICKFORD RI
02852-5116
US

IV. Provider business mailing address

250 W MAIN ST
WICKFORD RI
02852-5116
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-2527
  • Fax: 401-294-7870
Mailing address:
  • Phone: 401-295-2527
  • Fax: 401-294-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDCP00309
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: