Provider Demographics
NPI:1700883634
Name:KUNERTH, PATRICK STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:STEVEN
Last Name:KUNERTH
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 1:304 PINE ST
Mailing Address - Street 2:BOX 8
Mailing Address - City:NICOLLET
Mailing Address - State:MN
Mailing Address - Zip Code:56074
Mailing Address - Country:US
Mailing Address - Phone:507-232-2789
Mailing Address - Fax:507-232-2790
Practice Address - Street 1:304 PINE ST
Practice Address - Street 2:BOX 8
Practice Address - City:NICOLLET
Practice Address - State:MN
Practice Address - Zip Code:56074
Practice Address - Country:US
Practice Address - Phone:507-232-2789
Practice Address - Fax:507-232-2790
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4571804OtherMN TAX ID
MN48473KUOtherBLUE CROSS BLUE SHIELD