MEDICARE: DR. JOSHUA SETH BRUNAUGH D.C.

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06032054	OTHER	IL	BLUE CROSS BLUE SHIELD IL

General Provider Information

NPI Number	:	1982700431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA SETH BRUNAUGH D.C.

Provider Business Mailing Address
First Line	:	1000 BUSCH DR
Second Line	:
City	:	JERSEYVILLE
State	:	IL
Zip	:	62052-1087
Country	:	US
Telephone Number	:	618-498-4567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 DADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1685
Country	:	US
Telephone Number	:	618-467-0300
Fax Number	:	618-467-4065

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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