Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2008010491 | MO |
N | 111NP0017X | Pediatric Chiropractor | 2008010491 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 2008010491 | MO |
NPI | 1043484942 |
---|---|
Provider Name | Dr. Ashley Lauren Lane-Brunjes |
First Address | Labadie, MO 63055-1236 |
Second Address | Labadie, MO 63055-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 09/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000589812 | BSBC/ANTHEM ID# (01) | |
1104363 | UNITED HEALTH CARE ID# (01) | |
11863758 | CAQH ID (01) | MO |
2008010491 | LICENSE # (01) | MO |
48349 | ASH LINK ID# (01) | |
9258138 | AETNA ID# (01) | |
929264 | HEALTHLINK ID# (01) | |
MA1169 | MEDICARE PTAN GROUP # (01) | MO |
MA1169001 | MEDICARE PTAN INDIVIDUAL # (01) | MO |