Provider Demographics
NPI:1982700431
Name:BRUNAUGH, JOSHUA SETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SETH
Last Name:BRUNAUGH
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 1:1000 BUSCH DR
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1087
Mailing Address - Country:US
Mailing Address - Phone:618-498-4567
Mailing Address - Fax:
Practice Address - Street 1:1316 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1685
Practice Address - Country:US
Practice Address - Phone:618-467-0300
Practice Address - Fax:618-467-4065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06032054OtherBLUE CROSS BLUE SHIELD IL
IL204875Medicare ID - Type Unspecified
ILU94100Medicare UPIN