Provider Demographics
NPI:1508957150
Name:BRUINSMA, LINDA S (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:BRUINSMA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 BYRON CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519
Mailing Address - Country:US
Mailing Address - Phone:616-531-3566
Mailing Address - Fax:616-531-2715
Practice Address - Street 1:3555 BYRON CENTER AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-531-3566
Practice Address - Fax:616-531-2715
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52096OtherBLUE CORE NETWORK
MI950D150990OtherBCBS OF MICHIGAN
P33017Medicare UPIN
P52096OtherBLUE CORE NETWORK