Provider Demographics
NPI:1205041654
Name:SUNDBERG, NEAL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:DAVID
Last Name:SUNDBERG
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 1:111 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9410
Mailing Address - Country:US
Mailing Address - Phone:856-810-0646
Mailing Address - Fax:856-596-7462
Practice Address - Street 1:111 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9410
Practice Address - Country:US
Practice Address - Phone:856-810-0646
Practice Address - Fax:856-596-7462
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00321500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor