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General NPI Number Information
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NPI Number | 1245618420
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Entity Type | Individual
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Provider Name | MIRANDA BUNGE DC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 3407 FERN VALLEY RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-3529
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Country | US
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Telephone | 502-961-9355
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Fax | 502-961-9357
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Provider Business Mailing Address
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Address Line | 8678 RAMSEY LN
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City | DU QUOIN
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State | IL
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Zip | 62832-3862
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Country | US
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Telephone | 618-318-1351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1234
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5471
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License Number State | KY
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