Organization
BUNGE SPINE & PERFORMANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BUNGE DC (OWNER)
(417) 773-0516
Entity
Organization
Contact information
Practice address
5055 HIGHWAY N STE 108, COTTLEVILLE, MO 63304-8031
(417) 773-0516
(636) 685-0422
Mailing address
5055 HIGHWAY N STE 108, COTTLEVILLE, MO 63304-8031
(417) 773-0516
(636) 706-6171
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
2016044967
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016044967
STATE LICENSE NUMBER
MO
Enumeration date
06/06/2017
Last updated
06/12/2017
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