Provider Demographics
NPI:1649361569
Name:DUNKLE, SEAN REID (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:REID
Last Name:DUNKLE
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 1:1260 35TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1712
Mailing Address - Country:US
Mailing Address - Phone:319-377-7331
Mailing Address - Fax:319-377-1407
Practice Address - Street 1:1260 35TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1712
Practice Address - Country:US
Practice Address - Phone:319-377-7331
Practice Address - Fax:319-377-1407
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279281Medicaid
IA33389OtherBLUE CROSS/ BLUE SHIELD
IA0279281Medicaid