Healthcare Provider Details

I. General information

NPI: 1942350624
Provider Name (Legal Business Name): CHRISTOPHER ALAN BRUNO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11445 ISAAC NEWTON SQ S
RESTON VA
20190-5019
US

IV. Provider business mailing address

11445 ISAAC NEWTON SQ S
RESTON VA
20190-5019
US

V. Phone/Fax

Practice location:
  • Phone: 703-904-8230
  • Fax: 703-904-0574
Mailing address:
  • Phone: 703-904-8230
  • Fax: 703-904-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: