Jessica Bruin, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038011818 Issued in IL

Practice address

2710 E Lincoln St
Bloomington, IL 61704

Phone

(309) 662-8418

Fax

(309) 662-8197

NPI assigned

Nov 29, 2010

Last updated

Aug 27, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2010

Medicare assignment

May accept Medicare assignment

Group practices

Eastland Lifestyle CenterGroup PAC ID 0941581532, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eastland Lifestyle Center

  • Chiropractor
  • Bloomington, IL
  • NPI 1235688110
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1578865499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 E LINCOLN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046010",
            "telephone_number": "309-662-8418",
            "fax_number": "309-662-8197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 E LINCOLN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "61704",
            "telephone_number": "309-662-8418",
            "fax_number": "309-662-8197"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2406 E Washington St",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617044410",
            "country_code": "US",
            "telephone_number": "309-662-8418",
            "fax_number": "309-662-8197",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUIN",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-29",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "70011940",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Douglas Brownstone, MD
• Brenda Broy
• Peter John Brozenec, R.PH.
• Dennis M Brtva, O.D.
• Edmond Bruce, RPT
• William G Brunner, M.S., L.C.P.C.
• Kaya Buchanan, RDN
• Rachel Buchler
• Patricia A Buckley, P.T.
• Kylee Burcham, COTA

• Chiropractor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.