Provider Demographics
NPI:1134413420
Name:BRUNTON, PHILIP JOHN (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:BRUNTON
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 1:14367 SALTBY PL.
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609
Mailing Address - Country:US
Mailing Address - Phone:862-368-3342
Mailing Address - Fax:
Practice Address - Street 1:12082 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7371
Practice Address - Country:US
Practice Address - Phone:352-684-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor