Provider Demographics
NPI:1952590853
Name:BRUEGGEMAN CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:BRUEGGEMAN CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUEGGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-692-0000
Mailing Address - Street 1:108 MAGNOLIA DR STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1638
Mailing Address - Country:US
Mailing Address - Phone:618-692-0000
Mailing Address - Fax:618-655-1550
Practice Address - Street 1:108 MAGNOLIA DR STE A
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034
Practice Address - Country:US
Practice Address - Phone:618-692-0000
Practice Address - Fax:618-655-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208503Medicare PIN