Provider Demographics
NPI:1013285147
Name:DR. BUNYAD CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DR. BUNYAD CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNYAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-522-1300
Mailing Address - Street 1:208 E ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4426
Mailing Address - Country:US
Mailing Address - Phone:707-522-1300
Mailing Address - Fax:707-522-1313
Practice Address - Street 1:208 E ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4426
Practice Address - Country:US
Practice Address - Phone:707-522-1300
Practice Address - Fax:707-522-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31246111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty