Provider Demographics
NPI:1265183263
Name:CUNNINGHAM, DUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
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 1:209 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2262
Mailing Address - Country:US
Mailing Address - Phone:260-585-3871
Mailing Address - Fax:
Practice Address - Street 1:400 UNION ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2286
Practice Address - Country:US
Practice Address - Phone:260-499-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003275A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor