Bradley Brunner, DC, CCSP

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

038013262 Issued in IL

Practice address

214 Rousch St
Lena, IL 61048-8822

Phone

(843) 609-5944

NPI assigned

Apr 12, 2016

Last updated

Dec 3, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1144684564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 ROUSCH ST",
            "city": "LENA",
            "state": "IL",
            "postal_code": "610488822",
            "telephone_number": "843-609-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 ROUSCH ST",
            "city": "LENA",
            "state": "IL",
            "postal_code": "610488822",
            "telephone_number": "843-609-5944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DC, CCSP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IA",
            "license": "093348",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WI",
            "license": "5079-12",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038013262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Alexandra Bonjour, R.PH.
• Lynda A Borsdorf, CNP
• Carol Buss
• Chelsea R Davis, LCSW
• Kevin Daws
• Julio Delgadillo, NP
• Michelle A Dunker, PT

• Sports Physician Chiropractor in Lena, IL
• Providers in Lena, IL by specialty
• Sports Physician Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; 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.