Provider Demographics
NPI:1790895191
Name:HUNNEMEDER, GREGORY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROBERT
Last Name:HUNNEMEDER
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 1:1058 ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242
Mailing Address - Country:US
Mailing Address - Phone:609-886-7730
Mailing Address - Fax:609-889-9769
Practice Address - Street 1:1058 ROUTE 47
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242
Practice Address - Country:US
Practice Address - Phone:609-886-7730
Practice Address - Fax:609-889-9769
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350012507OtherRAILROAD MEDICARE
T44885Medicare UPIN
NJ409612Medicare ID - Type Unspecified