Provider Demographics
NPI:1417482084
Name:BORDUNOV, STEVEN S (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:BORDUNOV
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:P.O. BOX 1848
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948
Mailing Address - Country:US
Mailing Address - Phone:415-892-7560
Mailing Address - Fax:415-892-7509
Practice Address - Street 1:645 TAMALPAIS DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1613
Practice Address - Country:US
Practice Address - Phone:415-924-6500
Practice Address - Fax:415-924-2879
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor