Provider Demographics
NPI:1063491512
Name:HUNZIKER, JOHN CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:HUNZIKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 PACIFIC STREET
Mailing Address - Street 2:SUITE 318
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5480
Mailing Address - Country:US
Mailing Address - Phone:402-926-2584
Mailing Address - Fax:402-391-1646
Practice Address - Street 1:7701 PACIFIC STREET
Practice Address - Street 2:SUITE 318
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-926-2584
Practice Address - Fax:402-391-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE260678Medicare ID - Type Unspecified