Provider Demographics
NPI:1346430154
Name:BRUNKE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BRUNKE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-372-5602
Mailing Address - Street 1:205 MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3910
Mailing Address - Country:US
Mailing Address - Phone:831-372-5602
Mailing Address - Fax:831-372-5695
Practice Address - Street 1:205 MONTECITO AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3910
Practice Address - Country:US
Practice Address - Phone:831-372-5602
Practice Address - Fax:831-372-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29745ZMedicare PIN