Provider Demographics
NPI:1043484942
Name:LANE-BRUNJES, ASHLEY LAUREN (DC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREN
Last Name:LANE-BRUNJES
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 1:117 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LABADIE
Mailing Address - State:MO
Mailing Address - Zip Code:63055-1236
Mailing Address - Country:US
Mailing Address - Phone:636-742-3733
Mailing Address - Fax:
Practice Address - Street 1:108 FRONT STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:LABADIE
Practice Address - State:MO
Practice Address - Zip Code:63055-1301
Practice Address - Country:US
Practice Address - Phone:636-742-3733
Practice Address - Fax:636-742-3633
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008010491111NP0017X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104363OtherUNITED HEALTH CARE ID#
9258138OtherAETNA ID#
MO11863758OtherCAQH ID
929264OtherHEALTHLINK ID#
MOMA1169001OtherMEDICARE PTAN INDIVIDUAL #
000000589812OtherBSBC/ANTHEM ID#
48349OtherASH LINK ID#
MO2008010491OtherLICENSE #
MOMA1169OtherMEDICARE PTAN GROUP #