Provider Demographics
NPI:1184700502
Name:BRUNDAGE, BART ALLEN (DC)
Entity type:Individual
Prefix:MR
First Name:BART
Middle Name:ALLEN
Last Name:BRUNDAGE
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 1:8 BANTA ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532
Mailing Address - Country:US
Mailing Address - Phone:315-548-2225
Mailing Address - Fax:716-672-8711
Practice Address - Street 1:8 BANTA ST
Practice Address - Street 2:SUITE 406
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532
Practice Address - Country:US
Practice Address - Phone:315-548-2225
Practice Address - Fax:716-672-8711
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0097511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC2896Medicare ID - Type Unspecified