Individual
MITCHELL JACK KUNTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
443 N MAPLE ST, MANTENO, IL 60950-1096
(815) 928-7100
Mailing address
209 MAIN ST NW APT 2, BOURBONNAIS, IL 60914-1991
(309) 840-2011
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20000050506
2255A2300X - SPECIALIST/TECHNOLOGIST - ATHLETIC TRAINER
—
Enumeration date
04/14/2022
Last updated
01/12/2023
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