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NPI Code Detail

MEDICARE: DR. BROCK JAMES KUNZ D.C.

MEDICARE: DR. BROCK JAMES KUNZ 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
1111N00000XChiropractor4041OR

General Provider Information

NPI Number : 1386958130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BROCK JAMES KUNZ D.C.
Provider Business Mailing Address
First Line : 8029 S.E. WOODSTOCK BLVD.
Second Line :
City : PORTLAND
State : OR
Zip : 97206
Country : US
Telephone Number : 208-547-7601
Fax Number : 503-640-6279
Provider Business Practice Location Address
First Line : 8029 SE WOODSTOCK BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97206-5885
Country : US
Telephone Number : 208-547-7601
Fax Number : 503-640-6279
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2010
Last Update Date : 12/20/2010

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