Provider Demographics
NPI:1720362247
Name:KEMP, BRUCE R JR (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:KEMP
Suffix:JR
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 1:3642 N GAREY AVE
Mailing Address - Street 2:APT. #28
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1172
Mailing Address - Country:US
Mailing Address - Phone:626-354-6603
Mailing Address - Fax:
Practice Address - Street 1:373 S ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4978
Practice Address - Country:US
Practice Address - Phone:626-354-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor