Provider Demographics
NPI:1851059398
Name:BRUNK, GRADY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:LEE
Last Name:BRUNK
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 1:2441 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1240
Mailing Address - Country:US
Mailing Address - Phone:308-384-4955
Mailing Address - Fax:308-384-7088
Practice Address - Street 1:5012 3RD AVE STE 170
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8508
Practice Address - Country:US
Practice Address - Phone:308-222-4400
Practice Address - Fax:308-222-4038
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor