Provider Demographics
NPI:1508170382
Name:WUNDERLICH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WUNDERLICH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WUNDERLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-274-7660
Mailing Address - Street 1:6227 MCKEE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5178
Mailing Address - Country:US
Mailing Address - Phone:608-274-7660
Mailing Address - Fax:608-274-7667
Practice Address - Street 1:6227 MCKEE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5178
Practice Address - Country:US
Practice Address - Phone:608-274-7660
Practice Address - Fax:608-274-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3965-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty