Provider Demographics
NPI:1487423158
Name:GRUNKE, CHRISTOPHER ELLIOT JR (MAT, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ELLIOT
Last Name:GRUNKE
Suffix:JR
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1132
Mailing Address - Country:US
Mailing Address - Phone:402-215-3844
Mailing Address - Fax:
Practice Address - Street 1:801 17TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2226
Practice Address - Country:US
Practice Address - Phone:605-333-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer