Provider Demographics
NPI:1942747753
Name:BRUSNIGHAN, TANNER (DC)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:BRUSNIGHAN
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 1:1200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4157
Mailing Address - Country:US
Mailing Address - Phone:281-332-3428
Mailing Address - Fax:281-332-7593
Practice Address - Street 1:1200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4157
Practice Address - Country:US
Practice Address - Phone:281-332-3428
Practice Address - Fax:281-332-7593
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor