Provider Demographics
NPI:1093742843
Name:BRUNEY, MARY M (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:BRUNEY
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 1:6104 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1004
Mailing Address - Country:US
Mailing Address - Phone:614-847-9667
Mailing Address - Fax:614-847-9688
Practice Address - Street 1:6104 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1004
Practice Address - Country:US
Practice Address - Phone:614-847-9667
Practice Address - Fax:614-847-9688
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2007376Medicaid
OH2007376Medicaid
OHU63721Medicare UPIN