JACKSON RYAN BRUNNER

NORMAL, IL
NPI1821563453
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL  096.004944)
Enumeration Date2018-10-10
Last Update Date2021-09-28
Business Address
JACKSON RYAN BRUNNER LAT, ATC
7160 ATHLETICS KAUFMAN FOOTBALL BUILDING
NORMAL, IL 61790-6953
Phone number: 309-438-0607
Mailing Address
JACKSON RYAN BRUNNER LAT, ATC
7160 ATHLETICS KAUFMAN FOOTBALL BUILDING
NORMAL, IL 61790-0001
Phone number:
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