Provider Demographics
NPI:1881761237
Name:NORDSTROM, BRUCE E (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:NORDSTROM
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 1:9117 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-4110
Mailing Address - Country:US
Mailing Address - Phone:703-440-0072
Mailing Address - Fax:202-429-9699
Practice Address - Street 1:1600 K ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2806
Practice Address - Country:US
Practice Address - Phone:202-466-3803
Practice Address - Fax:202-429-9699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH14048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT84923Medicare UPIN
DCNO-046825Medicare ID - Type Unspecified