MEDICARE: CHANEL BUNCH LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	14743	NC

General Provider Information

NPI Number	:	1023728961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL BUNCH LMBT

Provider Business Mailing Address
First Line	:	3456 LACEWING DR
Second Line	:
City	:	ZEBULON
State	:	NC
Zip	:	27597-6275
Country	:	US
Telephone Number	:	919-492-9237
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 WIND CHIME CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6433
Country	:	US
Telephone Number	:	919-492-9237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/01/2022

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