Provider Demographics
NPI:1275719684
Name:BRETT JUNGMAN DC PLLC
Entity Type:Organization
Organization Name:BRETT JUNGMAN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:JUNGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-535-7099
Mailing Address - Street 1:1634 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4844
Mailing Address - Country:US
Mailing Address - Phone:806-535-7099
Mailing Address - Fax:
Practice Address - Street 1:1634 17TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4844
Practice Address - Country:US
Practice Address - Phone:806-535-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRR6828Medicare PIN
TXV03536Medicare UPIN
TX611303Medicare PIN