MEDICARE: DR. NICK ANTHONY KUENNEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2007011958	MO
2	111N00000X	Chiropractor	038-011148	IL

General Provider Information

NPI Number	:	1336345859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK ANTHONY KUENNEN D.C.

Provider Business Mailing Address
First Line	:	920 W VAN BUREN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3520
Country	:	US
Telephone Number	:	417-593-6037
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 W VAN BUREN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3520
Country	:	US
Telephone Number	:	417-593-6037
Fax Number	:	417-593-6037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	10/20/2010

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