Provider Demographics
NPI:1134311350
Name:MUNGER, PRUDENCE H (DC)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:H
Last Name:MUNGER
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 1:2034 ALGONAC DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4505
Mailing Address - Country:US
Mailing Address - Phone:810-280-6641
Mailing Address - Fax:
Practice Address - Street 1:526 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1357
Practice Address - Country:US
Practice Address - Phone:810-280-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4219111N00000X
OH2256111N00000X
SC1814111N00000X
GA5165111N00000X
MI2301006150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350OtherMEDICARE RAILROAD PROVIDE
GA35ZCDSHOtherMEDICARE PROVIDER
MI1730111303OtherCHIROPRACTIC