Provider Demographics
NPI:1518925031
Name:CUNNINGHAM, ROBERT J JR (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:CUNNINGHAM
Suffix:JR
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:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:828 S WABASH AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2181
Practice Address - Country:US
Practice Address - Phone:312-235-0355
Practice Address - Fax:312-235-0361
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208878/K13335Medicare ID - Type Unspecified
ILV02753Medicare UPIN