=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588891014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUNCH CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2009
-----------------------------------------------------
Last Update Date | 06/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3951 S PLAZA DR SUITE 150
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-7461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-751-8570
-----------------------------------------------------
Fax | 714-751-8568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3951 S PLAZA DR SUITE 150
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-7461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-751-8570
-----------------------------------------------------
Fax | 714-751-8568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAYMOND BUNCH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 714-751-8570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC20929
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------