Provider Demographics
NPI:1811037393
Name:BRUNELLE, JON PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:PATRICK
Last Name:BRUNELLE
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 1:4980 BARRANCA PKWY
Mailing Address - Street 2:SUITE 195
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8645
Mailing Address - Country:US
Mailing Address - Phone:949-784-4507
Mailing Address - Fax:949-872-2557
Practice Address - Street 1:4980 BARRANCA PKWY
Practice Address - Street 2:SUITE 195
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8645
Practice Address - Country:US
Practice Address - Phone:949-784-4507
Practice Address - Fax:949-872-2557
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23721Medicare ID - Type Unspecified