Provider Demographics
NPI:1407010812
Name:BRUNELLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BRUNELLE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MEDEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-295-2527
Mailing Address - Street 1:250 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5116
Mailing Address - Country:US
Mailing Address - Phone:401-295-2527
Mailing Address - Fax:401-294-7870
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5116
Practice Address - Country:US
Practice Address - Phone:401-295-2527
Practice Address - Fax:401-294-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI204087OtherBLUE CHIP
RI3519-6OtherBLUECROSS & BLUESHIELD OF RI
RIU22975Medicare UPIN
RI359003519Medicare PIN