Provider Demographics
NPI:1619937422
Name:BRUE CHIROPRACTIC
Entity Type:Organization
Organization Name:BRUE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-825-8182
Mailing Address - Street 1:63701 E SADDLEBROOKE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SADDLEBROOKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1273
Mailing Address - Country:US
Mailing Address - Phone:520-825-8182
Mailing Address - Fax:520-825-8192
Practice Address - Street 1:63701 E SADDLEBROOKE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:SADDLEBROOKE
Practice Address - State:AZ
Practice Address - Zip Code:85739-1273
Practice Address - Country:US
Practice Address - Phone:520-825-8182
Practice Address - Fax:520-825-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ84718Medicare ID - Type Unspecified