Healthcare Provider Details

I. General information

NPI: 1265225940
Provider Name (Legal Business Name): CALEB BUNTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N 5TH ST STE 302
ST AUGUSTINE FL
32084-1837
US

IV. Provider business mailing address

13 11TH ST
ST AUGUSTINE FL
32080-3841
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-6894
  • Fax: 904-788-7481
Mailing address:
  • Phone: 615-225-7186
  • Fax: 904-788-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CALEB BUNTING
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 904-217-6894