Provider Demographics
NPI:1114062155
Name:HOPPER, BRUCE KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:KENNETH
Last Name:HOPPER
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 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1438
Mailing Address - Country:US
Mailing Address - Phone:973-584-2990
Mailing Address - Fax:973-584-5197
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1438
Practice Address - Country:US
Practice Address - Phone:973-584-2990
Practice Address - Fax:973-584-5197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449621Medicare ID - Type Unspecified