# LOREN S BRUNNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1710105036
- **Gender:** Man
- **Credential:** DC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X009649 | NY | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 12/06/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 111N00000X | TAXONOMY | NY |
| 01 | — | 16-1587411 | TAX ID | NY |
| 01 | — | 1710105036 | CAQH | NY |
| 01 | — | C09649-7 | WORKMAN'S COMPENSATION | NY |
| 01 | — | J100057652 | TWIN CITY CHIROPRACTIC | NY |
| 01 | — | X009649-1 | LICENSE | NY |