Ashley Lauren Lane-Brunjes, D.C.
Individual provider Active NPI Chiropractor · Labadie, MO
NPI 1043484942 · NPPES record last updated Sep 9, 2019
Key facts
- NPI
- 1043484942
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2008010491 (MO)
- Practice address
- 108 Front Street
Suite 101
Labadie, MO 63055-1301 - Phone
- (636) 742-3733
- Fax
- (636) 742-3633
- NPI assigned
- Apr 22, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Back on Track Chiropractic, LLC
Back on Track Eureka LLC
Practice addresses (Care Compare)
117 Front St
Labadie, MO 63055-1238
Phone (636) 742-3733
409 Meramec Blvd
Eureka, MO 63025-3906
Phone (636) 429-2024
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080813000734 | MO | Practitioner - Chiropractic | 8224103056 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008010491 | MO | MD | Sports Physician Chiropractor |
Practice roles (3 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Back on Track Chiropractic, LLC | Chiropractor | Current |
Accepting new patients |
| Back on Track Eureka, LLC | Chiropractor | Current |
Accepting new patients |
| Chiropro of Eureka, LLC | Chiropractor | Past |
Accepting new patients |
Locations
409 Meramec Blvd
Eureka, MO 63025
Phone (636) 429-2024
117 Front St
Labadie, MO 63055
Phone (636) 742-3733
108 Front St
Ste 101
Labadie, MO 63055
Phone (636) 742-3733
Networks
- IA HMO
- IA HMO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Chiropractor | 111NP0017X | 2008010491 | MO | |
| Sports Physician Chiropractor | 111NS0005X | 2008010491 | MO | |
| Chiropractor | 111N00000X | 2008010491 | MO | Yes |
Addresses
Primary practice location
108 Front Street
Suite 101
Labadie, MO 63055-1301
Mailing address
117 Front St
Labadie, MO 63055-1236
Phone (636) 742-3733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104363 | Other | UNITED HEALTH CARE ID# | |
| 9258138 | Other | AETNA ID# | |
| 11863758 | Other | MO | CAQH ID |
| 929264 | Other | HEALTHLINK ID# | |
| MA1169001 | Other | MO | MEDICARE PTAN INDIVIDUAL # |
| 000000589812 | Other | BSBC/ANTHEM ID# | |
| 48349 | Other | ASH LINK ID# | |
| 2008010491 | Other | MO | LICENSE # |
| MA1169 | Other | MO | MEDICARE PTAN GROUP # |
Other providers in Labadie, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.