Provider Demographics
NPI:1073524914
Name:SUNDSTROM, CHADWICK M (DC)
Entity Type:Individual
Prefix:MR
First Name:CHADWICK
Middle Name:M
Last Name:SUNDSTROM
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 1:9295 E STOCKTON BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624
Mailing Address - Country:US
Mailing Address - Phone:916-685-6380
Mailing Address - Fax:916-685-4744
Practice Address - Street 1:9295 E STOCKTON BLVD
Practice Address - Street 2:STE 10
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624
Practice Address - Country:US
Practice Address - Phone:916-685-6380
Practice Address - Fax:916-685-4744
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251070Medicare ID - Type Unspecified