MEDICARE: JENNA BRUNETTE

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	111N00000X	Chiropractor	DC011236	PA

General Provider Information

NPI Number	:	1376074013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA BRUNETTE

Provider Business Mailing Address
First Line	:	26 JEFFERSON ST # 1
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9301 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2825
Country	:	US
Telephone Number	:	215-331-5954
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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Directions to “ JENNA BRUNETTE ” Practice Location

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