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General NPI Number Information
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NPI Number | 1780458810
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Entity Type | Organization
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Legal Business Name | HANNA BRUCKER LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 1860 CENTRE ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1902
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Country | US
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Telephone | 617-588-4272
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 CENTRE ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANNA BRUCKER
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Credential | DC
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Telephone | 401-744-0165
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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 |
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License Number State |
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