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General NPI Number Information
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NPI Number | 1194987974
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Entity Type | Organization
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Legal Business Name | BRUNS CHIROPRACTIC OFFICE SC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 800 W TRAILCREEK DR
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City | PEORIA
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State | IL
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Zip | 61614-1862
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Country | US
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Telephone | 309-693-3800
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Fax | 309-693-7816
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Provider Business Mailing Address
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Address Line | 800 W TRAILCREEK DR
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City | PEORIA
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State | IL
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Zip | 61614-1862
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Country | US
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Telephone | 309-693-3800
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Fax | 309-693-7816
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A BRUNS
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Credential | D.C.
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Telephone | 309-693-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038005300
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License Number State | IL
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