Provider Demographics
NPI:1902559735
Name:BUNTJER, BRIATTA (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIATTA
Middle Name:
Last Name:BUNTJER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 VILLAGE TRL UNIT 4-302
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9380
Mailing Address - Country:US
Mailing Address - Phone:507-531-6476
Mailing Address - Fax:
Practice Address - Street 1:357 WEKIVA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3607
Practice Address - Country:US
Practice Address - Phone:507-531-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor