Provider Demographics
NPI:1164968517
Name:BUNGE, WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BUNGE
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 1:5055 HIGHWAY N STE 108
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8031
Mailing Address - Country:US
Mailing Address - Phone:417-773-0516
Mailing Address - Fax:636-685-0422
Practice Address - Street 1:5055 HIGHWAY N STE 108
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8031
Practice Address - Country:US
Practice Address - Phone:417-773-0516
Practice Address - Fax:417-773-0516
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016044967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor