Provider Demographics
NPI:1992001259
Name:KUNZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KUNZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WAKLEY
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-354-4010
Mailing Address - Street 1:55 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5141
Mailing Address - Country:US
Mailing Address - Phone:208-354-4010
Mailing Address - Fax:
Practice Address - Street 1:55 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5141
Practice Address - Country:US
Practice Address - Phone:208-354-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty