Provider Demographics
NPI:1598764466
Name:WRIGHT, BRUCE D (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:WRIGHT
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:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-0631
Mailing Address - Country:US
Mailing Address - Phone:319-624-1444
Mailing Address - Fax:
Practice Address - Street 1:102 E MAIN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-0631
Practice Address - Country:US
Practice Address - Phone:319-624-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21211OtherWELLMARK
IA7900OtherMIDLANDS CHOICE
IA7001001OtherAETNA
IAI0008Medicare ID - Type Unspecified
IA7001001OtherAETNA
IA7900OtherMIDLANDS CHOICE