Provider Demographics
NPI:1902907322
Name:BRUNO, MICHAEL A (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 EAGLES LANDING PKWY # 10
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5096
Mailing Address - Country:US
Mailing Address - Phone:678-565-1500
Mailing Address - Fax:678-565-7411
Practice Address - Street 1:616 EAGLES LANDING PKWY # 10
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5096
Practice Address - Country:US
Practice Address - Phone:678-565-1500
Practice Address - Fax:678-565-7411
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR7373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHHBMedicare ID - Type Unspecified
GA95337Medicare UPIN