Individual provider Active NPI

John Luke Brungard, DC

  • Chiropractor
  • Eatontown, NJ
National Provider Identifier
1417450479
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00750900 Issued in NJ
Practice address
285 Parker Rd
Eatontown, NJ 07724-9621
Phone
(732) 229-3344
Fax
(732) 728-0870
NPI assigned
Mar 15, 2018
Last updated
Mar 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00750900 NJ Primary

Addresses

Primary practice location

285 Parker Rd
Eatontown, NJ 07724-9621

Mailing address

285 Parker Rd
Eatontown, NJ 07724-9621
Phone (732) 229-3344

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
38MC00750900NJMDChiropractor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1417450479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 PARKER RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077249621",
            "telephone_number": "732-229-3344",
            "fax_number": "732-728-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 PARKER RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077249621",
            "telephone_number": "732-229-3344",
            "fax_number": "732-728-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNGARD",
        "first_name": "JOHN",
        "middle_name": "LUKE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00750900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.