Provider Demographics
NPI:1639207442
Name:BRUNO, SUSAN (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRUNO
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 1:495 E LOS ANGELES AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7706
Mailing Address - Country:US
Mailing Address - Phone:805-527-6782
Mailing Address - Fax:805-527-9648
Practice Address - Street 1:495 E LOS ANGELES AVE STE 103
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-527-6782
Practice Address - Fax:805-527-9648
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor