Individual
MR. JACK MICHAEL BRUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1425 N RANDALL RD, ELGIN, IL 60123-2300
(847) 742-9800
Mailing address
6552 N OXFORD AVE, CHICAGO, IL 60631-1529
(941) 321-9790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.004840
IL
363A00000X
Physician Assistant
10002688A
IN
363A00000X
Physician Assistant
853623
WI
363AM0700X
Medical Physician Assistant
085004840
IL
Other
Enumeration date
09/30/2013
Last updated
11/24/2025
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