Provider Demographics
NPI:1568428308
Name:BRUNKEN, DAVID LAWRENCE (ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:BRUNKEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:27628 ROCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5732
Mailing Address - Country:US
Mailing Address - Phone:951-487-3598
Mailing Address - Fax:951-654-4572
Practice Address - Street 1:1499 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-2325
Practice Address - Country:US
Practice Address - Phone:951-487-3598
Practice Address - Fax:951-654-4572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer