Provider Demographics
NPI:1679028427
Name:BRUCKS, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BRUCKS
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 1:6701 E 134TH TER
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-3239
Mailing Address - Country:US
Mailing Address - Phone:816-547-9895
Mailing Address - Fax:
Practice Address - Street 1:731 NE LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1353
Practice Address - Country:US
Practice Address - Phone:816-373-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016015738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor