Individual
DR. LARRY DEAN BRUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
(618) 664-4600
Mailing address
919 E WINTER AVE, GREENVILLE, IL 62246-1963
(618) 664-0755
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-010373
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0332010
BCBS MIXED GROUP
IL
01
—
412192761
TAX ID
IL
01
—
738272
HEALTHLINK PPO
IL
Enumeration date
10/05/2006
Last updated
06/05/2008
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