Provider Demographics
NPI:1598845372
Name:BRUNO, JUDYTH A (D C)
Entity Type:Individual
Prefix:DR
First Name:JUDYTH
Middle Name:A
Last Name:BRUNO
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9381 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49967-9393
Mailing Address - Country:US
Mailing Address - Phone:906-852-3290
Mailing Address - Fax:906-852-3290
Practice Address - Street 1:20312 STATE HIGHWAY M28 STE A
Practice Address - Street 2:
Practice Address - City:EWEN
Practice Address - State:MI
Practice Address - Zip Code:49925-8001
Practice Address - Country:US
Practice Address - Phone:488-988-2080
Practice Address - Fax:906-988-2080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4176209Medicaid
MI950F650020OtherBCBSM
MIP00149612OtherRAILROAD MEDICARE
MIP91340Medicare UPIN
MI0M94140Medicare PIN