Provider Demographics
NPI:1255486973
Name:BUNCH, JESSICA STEPHANIE (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:STEPHANIE
Last Name:BUNCH
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 1:632 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129
Mailing Address - Country:US
Mailing Address - Phone:812-282-7500
Mailing Address - Fax:812-282-4552
Practice Address - Street 1:632 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129
Practice Address - Country:US
Practice Address - Phone:812-282-7500
Practice Address - Fax:812-282-4552
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5043111N00000X
IN08002334A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000553006OtherANTHEM
224090CMedicare PIN