Provider Demographics
NPI:1811299035
Name:KUNZ, ERIC WAKLEY (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WAKLEY
Last Name:KUNZ
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 1:5930 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:TETONIA
Mailing Address - State:ID
Mailing Address - Zip Code:83452-4943
Mailing Address - Country:US
Mailing Address - Phone:208-932-3359
Mailing Address - Fax:
Practice Address - Street 1:55 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5141
Practice Address - Country:US
Practice Address - Phone:208-354-4010
Practice Address - Fax:208-354-4011
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA - 1438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor