Provider Demographics
NPI:1033160619
Name:UNDERWOOD, WENDELL MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:MARTIN
Last Name:UNDERWOOD
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 1:2901 W SAINT ISABEL ST STE A2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6350
Mailing Address - Country:US
Mailing Address - Phone:813-644-7017
Mailing Address - Fax:813-436-5494
Practice Address - Street 1:2901 W SAINT ISABEL ST STE A2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-644-7017
Practice Address - Fax:813-436-5494
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU66820Medicare UPIN