Provider Demographics
NPI:1730577594
Name:BRUNS, HAVALYN (DC)
Entity type:Individual
Prefix:
First Name:HAVALYN
Middle Name:
Last Name:BRUNS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COBB PKWY S
Mailing Address - Street 2:STE. 190
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 COBB PKWY S
Practice Address - Street 2:STE. 190
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6544
Practice Address - Country:US
Practice Address - Phone:770-427-7387
Practice Address - Fax:770-426-1491
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor