Provider Demographics
NPI:1245365006
Name:BRUNTJEN, RODD BARCLAY (DC)
Entity type:Individual
Prefix:
First Name:RODD
Middle Name:BARCLAY
Last Name:BRUNTJEN
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 1:2233 ENERGY PARK DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108
Mailing Address - Country:US
Mailing Address - Phone:651-646-2233
Mailing Address - Fax:651-646-2936
Practice Address - Street 1:2233 ENERGY PARK DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-646-2233
Practice Address - Fax:651-646-2936
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003427Medicare ID - Type Unspecified