Provider Demographics
NPI:1205058195
Name:BRUNO, SHERRY L (DC)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:BRUNO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SYCAMORE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7912
Mailing Address - Country:US
Mailing Address - Phone:760-598-1021
Mailing Address - Fax:760-598-5584
Practice Address - Street 1:750 SYCAMORE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7912
Practice Address - Country:US
Practice Address - Phone:760-598-1021
Practice Address - Fax:760-598-5584
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18744Medicare ID - Type UnspecifiedCHIROPRACTOR