Provider Demographics
NPI:1376651950
Name:BUNN, CHRISTOPHER JOHN (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BUNN
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 1:1496 E 5600 S STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4823
Mailing Address - Country:US
Mailing Address - Phone:801-689-2592
Mailing Address - Fax:
Practice Address - Street 1:1496 E 5600 S STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4823
Practice Address - Country:US
Practice Address - Phone:016-892-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT287585-1202111N00000X
GACHIRO08351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT197164OtherALTIUS ID #
UT28758512077001OtherNON-TRAD BCBS #
UT28758512000001OtherTRAD BCBS ID #
UT2238351OtherUNITED HEALTH CARE
UT107012083102OtherSELECT HEALTH
UT107012083102OtherSELECT HEALTH
000057113Medicare PIN
UT2238351OtherUNITED HEALTH CARE