Provider Demographics
NPI:1063686400
Name:BRUYN, ROBERT JORDAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JORDAN
Last Name:BRUYN
Suffix:JR
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 1:2021 GALLATIN PIKE N STE 112
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2015
Mailing Address - Country:US
Mailing Address - Phone:615-859-7003
Mailing Address - Fax:
Practice Address - Street 1:2021 GALLATIN PIKE N STE 112
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2015
Practice Address - Country:US
Practice Address - Phone:615-859-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor