Provider Demographics
NPI:1659488310
Name:KUNKEL, KASEY DEAN (DC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:DEAN
Last Name:KUNKEL
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:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-0861
Mailing Address - Country:US
Mailing Address - Phone:254-386-4850
Mailing Address - Fax:254-386-4850
Practice Address - Street 1:103 N BELL ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1900
Practice Address - Country:US
Practice Address - Phone:254-386-4850
Practice Address - Fax:254-386-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606283OtherBLUE CROSS BLUE SHIELD
TX174273601Medicaid
TXU80790Medicare UPIN
TX609399Medicare ID - Type Unspecified