Individual
LOREN S BRUNNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
510 OLIVER ST, NORTH TONAWANDA, NY 14120-4300
(716) 693-5646
(716) 693-2667
Mailing address
510 OLIVER ST, NORTH TONAWANDA, NY 14120-4300
(716) 693-5646
(716) 693-2667
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X009649
NY
Other
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
Enumeration date
04/23/2007
Last updated
12/06/2014
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