Provider Demographics
NPI:1912908815
Name:BRUNELLO CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:BRUNELLO CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BRUNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-725-4500
Mailing Address - Street 1:600 E SMITH RD
Mailing Address - Street 2:STE A
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2666
Mailing Address - Country:US
Mailing Address - Phone:330-725-4500
Mailing Address - Fax:330-725-4504
Practice Address - Street 1:600 E SMITH RD
Practice Address - Street 2:STE A
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2666
Practice Address - Country:US
Practice Address - Phone:330-725-4500
Practice Address - Fax:330-725-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM4600OtherRAILROAD MEDICARE
OHCM4600OtherRAILROAD MEDICARE
T47451Medicare UPIN