Provider Demographics
NPI:1760755052
Name:CUNICO, CHARLES R (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:CUNICO
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 1:2965 LAVITA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6488
Mailing Address - Country:US
Mailing Address - Phone:479-200-1644
Mailing Address - Fax:
Practice Address - Street 1:624 E HENRI DE TONTI BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-9722
Practice Address - Country:US
Practice Address - Phone:479-361-1112
Practice Address - Fax:479-361-1120
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor