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General NPI Number Information
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NPI Number | 1558721209
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Entity Type | Individual
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Provider Name | TERRI LYNN BRUCATO D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 477 ROUTE 10 E SUITE 201
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City | RANDOLPH
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State | NJ
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Zip | 07869-2142
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Country | US
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Telephone | 973-534-5132
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Fax |
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Provider Business Mailing Address
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Address Line | 28 HERITAGE LN
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City | HAMBURG
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State | NJ
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Zip | 07419-1328
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Country | US
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Telephone | 973-534-5132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 38MC00569500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 38MC00569500
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License Number State | NJ
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