Provider Demographics
NPI:1881896504
Name:BRUNTON CHIROPRACTIC INC.
Entity type:Organization
Organization Name:BRUNTON CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-432-6459
Mailing Address - Street 1:105 N ROSE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-7222
Mailing Address - Country:US
Mailing Address - Phone:760-432-6459
Mailing Address - Fax:760-741-9355
Practice Address - Street 1:105 N ROSE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-7222
Practice Address - Country:US
Practice Address - Phone:760-432-6459
Practice Address - Fax:760-741-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty