Provider Demographics
NPI:1255430021
Name:HOMSEY, BRUCE DANIEL (DC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:DANIEL
Last Name:HOMSEY
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 1:5654 W BELL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3882
Mailing Address - Country:US
Mailing Address - Phone:602-843-2730
Mailing Address - Fax:
Practice Address - Street 1:5654 W BELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3882
Practice Address - Country:US
Practice Address - Phone:602-843-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0244500OtherBLUE CROSS & BLUE SHIELD
AZAZ0244500OtherBLUE CROSS & BLUE SHIELD