Provider Demographics
NPI:1992004733
Name:BAMFORTH, BRUCE W (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:BAMFORTH
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 1:87981 TAMORA DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-9517
Mailing Address - Country:US
Mailing Address - Phone:541-726-1978
Mailing Address - Fax:
Practice Address - Street 1:87981 TAMORA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-9517
Practice Address - Country:US
Practice Address - Phone:541-726-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor