Provider Demographics
NPI:1225727639
Name:BRUNSON, JUSTIN (PSS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:AUMSVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97325-8961
Mailing Address - Country:US
Mailing Address - Phone:503-569-5658
Mailing Address - Fax:
Practice Address - Street 1:280 NE SANTIAM BLVD
Practice Address - Street 2:
Practice Address - City:MILL CITY
Practice Address - State:OR
Practice Address - Zip Code:97360
Practice Address - Country:US
Practice Address - Phone:971-332-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000108652175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist