Provider Demographics
NPI:1154473338
Name:BRONSON CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BRONSON CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-373-7727
Mailing Address - Street 1:4409 S NOLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4742
Mailing Address - Country:US
Mailing Address - Phone:816-373-7727
Mailing Address - Fax:816-373-5757
Practice Address - Street 1:4409 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4742
Practice Address - Country:US
Practice Address - Phone:816-373-7727
Practice Address - Fax:816-373-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON500000Medicare ID - Type Unspecified
MOT73737Medicare UPIN