Active NPI
Adam Joseph Braunecker
- Athletic Trainer
- Huntingburg, IN
National Provider Identifier
1104290170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2243
- Practice address
- 3355 E 550S
Huntingburg, IN 47542-9552 - Phone
- (812) 639-7894
- NPI assigned
- Nov 13, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | 2243 | TN | Primary |
Addresses
Primary practice location
3355 E 550S
Huntingburg, IN 47542-9552
Mailing address
3309 Colchester Cir
Lebanon, TN 37087-8210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2243 | TN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547424000000",
"number": "1104290170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3309 COLCHESTER CIR",
"city": "LEBANON",
"state": "TN",
"postal_code": "370878210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3355 E 550S",
"city": "HUNTINGBURG",
"state": "IN",
"postal_code": "475429552",
"telephone_number": "812-639-7894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAUNECKER",
"first_name": "ADAM",
"middle_name": "JOSEPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-13",
"last_updated": "2019-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntingburg, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.