Provider Demographics
NPI:1457551772
Name:K W HUNNEMEDER, DC PC
Entity Type:Organization
Organization Name:K W HUNNEMEDER, DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUNNEMEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-249-5200
Mailing Address - Street 1:4211 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2134
Mailing Address - Country:US
Mailing Address - Phone:847-249-5200
Mailing Address - Fax:847-249-5204
Practice Address - Street 1:4211 GROVE AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2134
Practice Address - Country:US
Practice Address - Phone:847-249-5200
Practice Address - Fax:847-249-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03800365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004982027OtherBLUE CROSS BLUE SHIELD
IL200409Medicare PIN