Provider Demographics
NPI:1639306905
Name:CUNNING, JACK B (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:CUNNING
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 1:1643 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARRIORS MARK
Mailing Address - State:PA
Mailing Address - Zip Code:16877-6428
Mailing Address - Country:US
Mailing Address - Phone:814-632-9865
Mailing Address - Fax:
Practice Address - Street 1:1643 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WARRIORS MARK
Practice Address - State:PA
Practice Address - Zip Code:16877-6428
Practice Address - Country:US
Practice Address - Phone:814-632-9865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003217-L111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician