Provider Demographics
NPI:1831217165
Name:ESHETE, BRUCK (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCK
Middle Name:
Last Name:ESHETE
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 1:3721 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2709
Mailing Address - Country:US
Mailing Address - Phone:612-825-1250
Mailing Address - Fax:612-825-2911
Practice Address - Street 1:3721 13TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2709
Practice Address - Country:US
Practice Address - Phone:612-825-1250
Practice Address - Fax:612-825-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor