Provider Demographics
NPI:1952718249
Name:BRUNER, DEREK PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:PAUL
Last Name:BRUNER
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 1:1858 KELLER PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3758
Mailing Address - Country:US
Mailing Address - Phone:817-431-9911
Mailing Address - Fax:817-431-3900
Practice Address - Street 1:1858 KELLER PKWY STE C
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3758
Practice Address - Country:US
Practice Address - Phone:817-431-9911
Practice Address - Fax:817-431-3900
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor