Provider Demographics
NPI:1336401637
Name:PUNGPADUNG, NUNTIKA (DC)
Entity Type:Individual
Prefix:DR
First Name:NUNTIKA
Middle Name:
Last Name:PUNGPADUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NUNTIKA
Other - Middle Name:PUNGPADUNG
Other - Last Name:BRINEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1330 E 8TH ST
Mailing Address - Street 2:SUITE #111
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 E 8TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4702
Practice Address - Country:US
Practice Address - Phone:432-614-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor