Provider Demographics
NPI:1114199247
Name:BRUMMOND, DENNIS ROBERT (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ROBERT
Last Name:BRUMMOND
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 STILLWATER BLVD N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5485
Mailing Address - Country:US
Mailing Address - Phone:651-439-2004
Mailing Address - Fax:651-689-1636
Practice Address - Street 1:6750 STILLWATER BLVD N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5485
Practice Address - Country:US
Practice Address - Phone:651-439-2004
Practice Address - Fax:651-689-1636
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor