Provider Demographics
NPI:1619306032
Name:BUNGE CHIROPRACTIC HEALTH CLINIC
Entity Type:Organization
Organization Name:BUNGE CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUNGE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:814-880-1741
Mailing Address - Street 1:39 PERSIMMONS ST STE 603
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7648
Mailing Address - Country:US
Mailing Address - Phone:814-880-1741
Mailing Address - Fax:
Practice Address - Street 1:39 PERSIMMONS ST STE 603
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7648
Practice Address - Country:US
Practice Address - Phone:814-880-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3865261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center