Provider Demographics
NPI:1841208295
Name:BUNTING, GREGORY W (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:BUNTING
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 1:2922 OAK LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4131
Mailing Address - Country:US
Mailing Address - Phone:214-219-4325
Mailing Address - Fax:214-526-2267
Practice Address - Street 1:2922 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4131
Practice Address - Country:US
Practice Address - Phone:214-219-4325
Practice Address - Fax:214-526-2267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605117Medicaid
TX605117Medicare ID - Type Unspecified
TX605117Medicaid