Healthcare Provider Details

I. General information

NPI: 1013980119
Provider Name (Legal Business Name): JOSEPH GERARD CUNNIFF D.C. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 WOODWINDS DR STE 100
WOODBURY MN
55125-2522
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5201
  • Fax:
Mailing address:
  • Phone: 651-968-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number6414842-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number45952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: