Healthcare Provider Details

I. General information

NPI: 1285628479
Provider Name (Legal Business Name): DANIEL V GRUNERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CAPISTA DR
SHOREWOOD IL
60404-8551
US

IV. Provider business mailing address

127 CAPISTA DR
SHOREWOOD IL
60404-8551
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-6150
  • Fax: 219-203-2925
Mailing address:
  • Phone: 815-609-6150
  • Fax: 219-203-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: