Provider Demographics
NPI:1790023257
Name:KUNKLE, JAMIE MATTHEW (ND)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MATTHEW
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 GIBSON DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5881
Mailing Address - Country:US
Mailing Address - Phone:814-494-2129
Mailing Address - Fax:
Practice Address - Street 1:254 GIBSON DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5881
Practice Address - Country:US
Practice Address - Phone:814-494-2129
Practice Address - Fax:916-351-5600
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60320954175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath