Provider Demographics
NPI:1821425331
Name:CUNNINGHAM, CAROLYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYNN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CAROLYNN
Other - Middle Name:
Other - Last Name:CASALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:24870 S TAMIAMI TRL
Mailing Address - Street 2:STE 3
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7014
Mailing Address - Country:US
Mailing Address - Phone:239-676-3663
Mailing Address - Fax:239-908-0440
Practice Address - Street 1:24870 S TAMIAMI TRL
Practice Address - Street 2:STE 3
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7014
Practice Address - Country:US
Practice Address - Phone:239-676-3663
Practice Address - Fax:239-908-0440
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor