Provider Demographics
NPI:1154786580
Name:CUNNINGHAM, DANE (DC)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:
Last Name:CUNNINGHAM
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:PO BOX 110052
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0101
Mailing Address - Country:US
Mailing Address - Phone:978-340-1045
Mailing Address - Fax:
Practice Address - Street 1:24870 S TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7012
Practice Address - Country:US
Practice Address - Phone:800-596-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor