=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265225940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALEB BUNTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 N 5TH ST STE 302
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-217-6894
-----------------------------------------------------
Fax | 904-788-7481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 11TH ST
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-225-7186
-----------------------------------------------------
Fax | 904-788-7481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. CALEB BUNTING
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 904-217-6894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------