Provider Demographics
NPI:1871051839
Name:KUEHNE, CHADWICK
Entity type:Individual
Prefix:
First Name:CHADWICK
Middle Name:
Last Name:KUEHNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 DAILETTE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-4903
Mailing Address - Country:US
Mailing Address - Phone:815-484-3353
Mailing Address - Fax:
Practice Address - Street 1:4405 HIGHCREST RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1452
Practice Address - Country:US
Practice Address - Phone:815-229-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant