Provider Demographics
NPI:1417450479
Name:BRUNGARD, JOHN LUKE (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LUKE
Last Name:BRUNGARD
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 1:285 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-9621
Mailing Address - Country:US
Mailing Address - Phone:732-229-3344
Mailing Address - Fax:732-728-0870
Practice Address - Street 1:285 PARKER RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-9621
Practice Address - Country:US
Practice Address - Phone:732-229-3344
Practice Address - Fax:732-728-0870
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00750900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor