Provider Demographics
NPI:1780893313
Name:SHUNKWILER, KIM ROBERTS (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:ROBERTS
Last Name:SHUNKWILER
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 1:5978 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3170
Mailing Address - Country:US
Mailing Address - Phone:734-728-5533
Mailing Address - Fax:734-728-8132
Practice Address - Street 1:5978 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3170
Practice Address - Country:US
Practice Address - Phone:734-728-5533
Practice Address - Fax:734-728-8132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor