Provider Demographics
NPI:1093852857
Name:BRUCK, ROBIN (DC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:603-626-3900
Mailing Address - Fax:603-626-3908
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-626-3900
Practice Address - Fax:603-626-3908
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0041289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4517Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
NHNA1716Medicare UPIN
NH615530Medicare UPIN