Provider Demographics
NPI:1083328462
Name:BRUNA, JAKE VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:VINCENT
Last Name:BRUNA
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 1:21640 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9064
Mailing Address - Country:US
Mailing Address - Phone:913-422-1900
Mailing Address - Fax:
Practice Address - Street 1:21640 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66218-9064
Practice Address - Country:US
Practice Address - Phone:913-422-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor