Provider Demographics
NPI:1043254956
Name:BRUNO, THOMAS W (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747
Mailing Address - Country:US
Mailing Address - Phone:732-583-7722
Mailing Address - Fax:732-583-9197
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-583-7722
Practice Address - Fax:732-583-9197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
156792OtherONE HEALTH
NJ538053OtherAETNA
050002507NJ01OtherANTHEM HEALTH
0094582OtherGHI
0730004000OtherAMERIHEALTH
NJ378136OtherUNITED HEALTH
X47221OtherEMPIRE BCBS
NJ1089803Medicaid
P413276OtherOXFORD
NJ538053OtherAETNA
449996Medicare ID - Type Unspecified