Provider Demographics
NPI:1336303734
Name:SHUNKWILER SPINE & SPORTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SHUNKWILER SPINE & SPORTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHUNKWILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-440-0817
Mailing Address - Street 1:6171 LAROCHE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6058
Mailing Address - Country:US
Mailing Address - Phone:402-261-3291
Mailing Address - Fax:
Practice Address - Street 1:4400 S 70TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6711
Practice Address - Country:US
Practice Address - Phone:314-440-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty