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General NPI Number Information
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NPI Number | 1942978473
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Entity Type | Individual
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Provider Name | ROSARIO ROBERT BRUNO DC, MS, CSCS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 112 W BETHALTO BLVD
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City | BETHALTO
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State | IL
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Zip | 62010-1703
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Country | US
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Telephone | 618-717-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 119 E DUNN ST
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1101
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Country | US
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Telephone | 813-226-7230
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.013764
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License Number State | IL
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