Provider Demographics
NPI:1689755407
Name:BRUNS, DEAN ERVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ERVIN
Last Name:BRUNS
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 1:203 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3765
Mailing Address - Country:US
Mailing Address - Phone:507-532-2203
Mailing Address - Fax:507-532-2204
Practice Address - Street 1:203 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3765
Practice Address - Country:US
Practice Address - Phone:507-532-2203
Practice Address - Fax:507-532-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN95D22BROtherBCBS