Provider Demographics
NPI:1679770374
Name:BUNNING, TODD WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WAYNE
Last Name:BUNNING
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 1:530 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2621
Mailing Address - Country:US
Mailing Address - Phone:916-782-3141
Mailing Address - Fax:916-782-8196
Practice Address - Street 1:530 OAK ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2621
Practice Address - Country:US
Practice Address - Phone:916-782-3141
Practice Address - Fax:916-782-8196
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor