Healthcare Provider Details

I. General information

NPI: 1871644351
Provider Name (Legal Business Name): JASON GREGORY BUNK D.C., ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 SE FEDERAL HWY SUITE 201
STUART FL
34994-3949
US

IV. Provider business mailing address

1989 SE FEDERAL HWY SUITE 201
STUART FL
34994-3949
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-1816
  • Fax: 772-781-1876
Mailing address:
  • Phone: 772-781-1816
  • Fax: 772-781-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8783
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9322762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: