Provider Demographics
NPI:1134285307
Name:BRONCOR INC
Entity Type:Organization
Organization Name:BRONCOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-342-3218
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1527
Mailing Address - Country:US
Mailing Address - Phone:217-342-3218
Mailing Address - Fax:217-342-3226
Practice Address - Street 1:813 N 3RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3181
Practice Address - Country:US
Practice Address - Phone:217-342-3218
Practice Address - Fax:217-342-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty