Provider Demographics
NPI:1174660070
Name:BRUNNER, COREY (DC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:BRUNNER
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 1:22 SOUTH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2247
Mailing Address - Country:US
Mailing Address - Phone:508-435-2225
Mailing Address - Fax:508-435-0195
Practice Address - Street 1:22 SOUTH ST STE 204
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2247
Practice Address - Country:US
Practice Address - Phone:508-435-2225
Practice Address - Fax:508-435-0195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45267Medicare PIN