Healthcare Provider Details

I. General information

NPI: 1700404035
Provider Name (Legal Business Name): KUNEVICH CHIROPRACTIC AND ACUPUNCTURE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 S MAIN ST STE 3
SMITHTON IL
62285-1705
US

IV. Provider business mailing address

724 LUNCH RD
SMITHTON IL
62285-2544
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-1177
  • Fax:
Mailing address:
  • Phone: 618-520-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE EDITH KUNEVICH
Title or Position: MANAGER
Credential: DC
Phone: 618-520-1177