Provider Demographics
NPI:1164997938
Name:BRUENING TOTAL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BRUENING TOTAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BRUENING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-223-6170
Mailing Address - Street 1:1210 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2233
Mailing Address - Country:US
Mailing Address - Phone:217-223-6170
Mailing Address - Fax:217-223-6177
Practice Address - Street 1:1210 N 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2233
Practice Address - Country:US
Practice Address - Phone:217-223-6170
Practice Address - Fax:217-223-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty