Provider Demographics
NPI:1902846835
Name:BRUCE, HENRY ELLINGER JR (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ELLINGER
Last Name:BRUCE
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 1:708 STATION AVENUE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-547-6587
Mailing Address - Fax:856-547-6995
Practice Address - Street 1:708 STATION AVENUE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035
Practice Address - Country:US
Practice Address - Phone:856-547-6587
Practice Address - Fax:856-547-6995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00106300111N00000X
SC2234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T73068Medicare UPIN
063958Medicare ID - Type Unspecified