Provider Demographics
NPI:1821299546
Name:BRUNETTE, MICHAEL ROYCE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROYCE
Last Name:BRUNETTE
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 1:101 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802
Mailing Address - Country:US
Mailing Address - Phone:509-886-0131
Mailing Address - Fax:509-884-8153
Practice Address - Street 1:101 11TH ST NE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4481
Practice Address - Country:US
Practice Address - Phone:509-886-0131
Practice Address - Fax:509-884-8153
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30242111N00000X
IDCHIA 1456111N00000X
WACH 60506492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor