Provider Demographics
NPI:1629043187
Name:BUNCH, SCOTTY (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:
Last Name:BUNCH
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 1:3831 RUCKRIEGEL PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4199
Mailing Address - Country:US
Mailing Address - Phone:620-431-6513
Mailing Address - Fax:620-431-6514
Practice Address - Street 1:3831 RUCKRIEGEL PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4199
Practice Address - Country:US
Practice Address - Phone:620-431-6513
Practice Address - Fax:620-431-6514
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS3651111N00000X
KY251610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060873Medicare UPIN
KST43809Medicare ID - Type Unspecified