Provider Demographics
NPI:1285628479
Name:GRUNERT, DANIEL V (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:V
Last Name:GRUNERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CAPISTA DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8551
Mailing Address - Country:US
Mailing Address - Phone:815-609-6150
Mailing Address - Fax:219-203-2925
Practice Address - Street 1:127 CAPISTA DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8551
Practice Address - Country:US
Practice Address - Phone:815-609-6150
Practice Address - Fax:219-203-2925
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915367OtherBLUE SHIELD
IL1285628479OtherNATIONAL PROVIDER IDENTIFIER
IL1285628479OtherNATIONAL PROVIDER IDENTIFIER
IL363823524OtherEMPLOYER IDENTIFICATION NUMBER