Provider Demographics
NPI:1093720864
Name:KLINEKOLE, BRUCE WAYNE (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:KLINEKOLE
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MECHEM DR STE C
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6950
Mailing Address - Country:US
Mailing Address - Phone:505-257-7970
Mailing Address - Fax:505-257-7970
Practice Address - Street 1:500 MECHEM DR STE C
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6950
Practice Address - Country:US
Practice Address - Phone:505-257-7970
Practice Address - Fax:505-257-7970
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1375111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51562OtherHMO NEW MEXICO
NML4208Medicaid
NMKC53OtherBLUE CROSS BLUE SHIELD
NM51562OtherHMO NEW MEXICO