Provider Demographics
NPI:1760562847
Name:JUNGMAN, BRETT SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:SHANE
Last Name:JUNGMAN
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 1:1634 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4844
Mailing Address - Country:US
Mailing Address - Phone:806-535-7099
Mailing Address - Fax:
Practice Address - Street 1:1634 17TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4844
Practice Address - Country:US
Practice Address - Phone:806-535-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03536Medicare UPIN
TX611303Medicare ID - Type UnspecifiedMEDICARE PART B
TXRR6828Medicare ID - Type UnspecifiedRAILROAD MEDICARE PART B