Provider Demographics
NPI:1114077542
Name:SUNDERLAGE, JOY L (DC, L AC,, DICCP)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:L
Last Name:SUNDERLAGE
Suffix:
Gender:F
Credentials:DC, L AC,, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2003
Mailing Address - Country:US
Mailing Address - Phone:847-888-3133
Mailing Address - Fax:
Practice Address - Street 1:1000 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2003
Practice Address - Country:US
Practice Address - Phone:847-888-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL631710Medicare ID - Type Unspecified