Provider Demographics
NPI:1447623798
Name:BRUNS, ANDREW MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BRUNS
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 1:110 HIGH ST # 2F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3815
Mailing Address - Country:US
Mailing Address - Phone:207-249-9986
Mailing Address - Fax:
Practice Address - Street 1:2 CHRISTENSEN LN STE 1
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7759
Practice Address - Country:US
Practice Address - Phone:207-249-9986
Practice Address - Fax:207-888-9592
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor