Provider Demographics
NPI:1518020700
Name:BREUNIG, CARLA JEAN (DC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:BREUNIG
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 1:570 ASBURY STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1852
Mailing Address - Country:US
Mailing Address - Phone:651-310-0000
Mailing Address - Fax:651-389-9491
Practice Address - Street 1:570 ASBURY STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1852
Practice Address - Country:US
Practice Address - Phone:651-310-0000
Practice Address - Fax:651-389-9491
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C181BROtherBCBS
MN465860400Medicaid
350002980Medicare ID - Type Unspecified
U53479Medicare UPIN