Provider Demographics
NPI:1558581686
Name:GUNDERMAN, WILLIAM J (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:GUNDERMAN
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 1:20231 E OCOTILLO RD
Mailing Address - Street 2:1
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242
Mailing Address - Country:US
Mailing Address - Phone:480-987-0585
Mailing Address - Fax:480-987-0585
Practice Address - Street 1:20231 E OCOTILLO RD
Practice Address - Street 2:1
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242
Practice Address - Country:US
Practice Address - Phone:480-987-0585
Practice Address - Fax:480-987-0585
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4962111N00000X
AZ2736111NT0100X
AZ394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NT0100XChiropractic ProvidersChiropractorThermography
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0241820OtherBLUE CROSS BLUE SHIELD
AZAZ0241820OtherBLUE CROSS BLUE SHIELD