Judyth A. Bruno, D. C.
Individual provider Active NPI Chiropractor · Ewen, MI
NPI 1598845372 · NPPES record last updated Aug 16, 2023
Key facts
- NPI
- 1598845372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301005866 (MI)
- Practice address
- 20312 State Highway M28 Ste a
Ewen, MI 49925-8001 - Phone
- (488) 988-2080
- Fax
- (906) 988-2080
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061228000154 | MI | Practitioner - Chiropractic | 2668472515 | Practice locations: Ontonagon, MI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2301005866 | MI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301005866 | MI | Yes |
Addresses
Primary practice location
20312 State Highway M28 Ste a
Ewen, MI 49925-8001
Mailing address
9381 Loop Rd
Trout Creek, MI 49967-9393
Phone (906) 852-3290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4176209 | Medicaid | MI | |
| 950F650020 | Other | MI | BCBSM |
| P00149612 | Other | MI | RAILROAD MEDICARE |
Other providers in Ewen, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.