Individual
DR. BRADLEY BRUNNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, CCSP
Contact information
Practice address
214 ROUSCH ST, LENA, IL 61048-8822
(843) 609-5944
Mailing address
214 ROUSCH ST, LENA, IL 61048-8822
(843) 609-5944
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038013262
IL
111NS0005X
Sports Physician Chiropractor
093348
IA
111NS0005X
Sports Physician Chiropractor
5079-12
WI
Other
Enumeration date
04/12/2016
Last updated
12/03/2018
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