Provider Demographics
NPI:1841359874
Name:BRUNDELL, EDMUND DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:DAVID
Last Name:BRUNDELL
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 1:900 SW 28TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4295
Mailing Address - Country:US
Mailing Address - Phone:239-772-0833
Mailing Address - Fax:
Practice Address - Street 1:9138 BONITA BEACH RD SE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4291
Practice Address - Country:US
Practice Address - Phone:239-947-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55595OtherBLUE CROSS BLUE SHIELD
FL55595AMedicare ID - Type Unspecified