Provider Demographics
NPI:1417383365
Name:BUNGE, SAMANTHA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JEAN
Last Name:BUNGE
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 1:6105 OLEANDER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4790
Mailing Address - Country:US
Mailing Address - Phone:910-769-2338
Mailing Address - Fax:
Practice Address - Street 1:6105 OLEANDER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4790
Practice Address - Country:US
Practice Address - Phone:910-769-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor