Provider Demographics
NPI:1740266808
Name:BRUNELLE, VINCENT EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:EDWARD
Last Name:BRUNELLE
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 1:250 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICKFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5116
Mailing Address - Country:US
Mailing Address - Phone:401-295-2527
Mailing Address - Fax:401-294-7870
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WICKFORD
Practice Address - State:RI
Practice Address - Zip Code:02852-5116
Practice Address - Country:US
Practice Address - Phone:401-295-2527
Practice Address - Fax:401-294-7870
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
359003519Medicare ID - Type Unspecified
U22975Medicare UPIN