Provider Demographics
NPI:1386958130
Name:KUNZ, BROCK JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:JAMES
Last Name:KUNZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 S.E. WOODSTOCK BLVD.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206
Mailing Address - Country:US
Mailing Address - Phone:208-547-7601
Mailing Address - Fax:503-640-6279
Practice Address - Street 1:8029 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5885
Practice Address - Country:US
Practice Address - Phone:208-547-7601
Practice Address - Fax:503-640-6279
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor