Provider Demographics
NPI:1144374059
Name:KUNZLER, MICHAEL P (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:KUNZLER
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 1:471 HERITAGE PARK BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5712
Mailing Address - Country:US
Mailing Address - Phone:801-525-1471
Mailing Address - Fax:801-525-1473
Practice Address - Street 1:471 HERITAGE PARK BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5712
Practice Address - Country:US
Practice Address - Phone:801-525-1471
Practice Address - Fax:801-525-1473
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU73836Medicare UPIN