Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 10633 | FL |
N | 111NN1001X | Nutrition | CH10633 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | CH10633 | FL |
Y | 111NS0005X | Chiropractic Sports Physician | CH10633 | FL |
NPI | 1255691440 |
---|---|
Provider Name | Jamie Lynne Brunet |
First Address | Tampa, FL 33606-1303 |
Second Address | Tampa, FL 33606-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 22/07/2021 |