Tyler Brucker, A.T.C.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

10 Doctors Park
Gibson City, IL 60936-2009

Phone

(217) 781-2560

NPI assigned

Nov 29, 2007

Last updated

Nov 29, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196294400000",
    "number": "1104008333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 N 200E RD",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609367194",
            "telephone_number": "217-781-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609362009",
            "telephone_number": "217-781-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "TYLER",
        "credential": "A.T.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marco S Boscolo, ATC
• Donna J Boundy, DMD MS
• Madison Briggs, COTA/L
• Laura B Brinkley, NP
• Kevin Allen Brucker, D.M.D.
• Caroline Bryan, CRNA
• Amanda Jean Buckner, NP
• Jesse Paul Butler, M.D.
• Mark A Cabelin, M.D.
• Katie S Cafarelli, MSW, LCSW

• Athletic Trainer in Gibson City, IL
• Providers in Gibson City, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.