Provider Demographics
NPI:1861881138
Name:PRUDENCE H MUNGER DC PLC
Entity type:Organization
Organization Name:PRUDENCE H MUNGER DC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRUDENCE
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:MUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-282-0074
Mailing Address - Street 1:2025 RICE PIKE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8403
Mailing Address - Country:US
Mailing Address - Phone:859-322-8570
Mailing Address - Fax:877-792-6209
Practice Address - Street 1:71 CAVALIER BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5121
Practice Address - Country:US
Practice Address - Phone:859-282-0074
Practice Address - Fax:877-792-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty