Provider Demographics
NPI:1043576093
Name:BRUCK, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:BRUCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BRUCK
Other - Last Name:CRETSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1 OVERLOOK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2800
Mailing Address - Country:US
Mailing Address - Phone:603-673-5600
Mailing Address - Fax:603-673-4477
Practice Address - Street 1:1 OVERLOOK DR STE 7
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2800
Practice Address - Country:US
Practice Address - Phone:603-673-5600
Practice Address - Fax:603-673-4477
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2390496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU61745Medicare UPIN