Individual
ADAM W BRUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
420 SOCIETY HILL DR, SUITE 200, AIKEN, SC 29803-1731
(803) 649-7266
(803) 649-7158
Mailing address
367 S. GULPH RD, ATT: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(803) 649-7266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1639
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016397
—
SC
Enumeration date
06/30/2008
Last updated
02/23/2019
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