Provider Demographics
NPI:1578865499
Name:BRUIN, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BRUIN
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 1:2710 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6010
Mailing Address - Country:US
Mailing Address - Phone:309-662-8418
Mailing Address - Fax:309-662-8197
Practice Address - Street 1:2710 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-662-8418
Practice Address - Fax:309-662-8197
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011940111N00000X
IL038011818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor