Provider Demographics
NPI:1114226560
Name:BRUNO, KIM EVANS (DC, CCN)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:EVANS
Last Name:BRUNO
Suffix:
Gender:F
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3218
Mailing Address - Country:US
Mailing Address - Phone:970-691-3694
Mailing Address - Fax:970-482-7800
Practice Address - Street 1:3020 CHAMPION CIR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4982
Practice Address - Country:US
Practice Address - Phone:970-691-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6183111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition