Provider Demographics
NPI:1477720548
Name:KUNTZ, DAVID LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:KUNTZ
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 1:1407 RACINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1467
Mailing Address - Country:US
Mailing Address - Phone:262-728-9998
Mailing Address - Fax:
Practice Address - Street 1:1407 RACINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1467
Practice Address - Country:US
Practice Address - Phone:262-728-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor