Provider Demographics
NPI:1154306744
Name:DE BRUIN, JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DE BRUIN
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 1:8010 E MCDOWELL RD
Mailing Address - Street 2:123
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3867
Mailing Address - Country:US
Mailing Address - Phone:480-946-4476
Mailing Address - Fax:480-946-3024
Practice Address - Street 1:8010 E MCDOWELL RD
Practice Address - Street 2:123
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3867
Practice Address - Country:US
Practice Address - Phone:480-946-4476
Practice Address - Fax:480-946-3024
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor