Provider Demographics
NPI:1942350624
Name:BRUNO, CHRISTOPHER ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALAN
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 1:11445 ISAAC NEWTON SQ S
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5019
Mailing Address - Country:US
Mailing Address - Phone:703-904-8230
Mailing Address - Fax:703-904-0574
Practice Address - Street 1:11445 ISAAC NEWTON SQ S
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5019
Practice Address - Country:US
Practice Address - Phone:703-904-8230
Practice Address - Fax:703-904-0574
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABR790429Medicare ID - Type Unspecified