Provider Demographics
NPI:1326129537
Name:RUNDLE, SEAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:SCOTT
Last Name:RUNDLE
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 1:25401 CABOT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5524
Mailing Address - Country:US
Mailing Address - Phone:949-588-7011
Mailing Address - Fax:949-588-7012
Practice Address - Street 1:25401 CABOT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5524
Practice Address - Country:US
Practice Address - Phone:949-588-7011
Practice Address - Fax:949-588-7012
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD913ZMedicare PIN