Provider Demographics
NPI:1932260387
Name:GRUNEWALD, STEVEN R (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:GRUNEWALD
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 1:1630 S GALENA AVE STE A
Mailing Address - Street 2:P.O. BOX 754
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-2518
Mailing Address - Country:US
Mailing Address - Phone:815-233-2254
Mailing Address - Fax:815-233-2253
Practice Address - Street 1:1630 S GALENA AVE
Practice Address - Street 2:STE A
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-2518
Practice Address - Country:US
Practice Address - Phone:815-233-2254
Practice Address - Fax:815-233-2253
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL552470Medicare ID - Type Unspecified
ILU62604Medicare UPIN