Provider Demographics
NPI:1851539035
Name:GUNDERMAN, SAMUEL J III (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:GUNDERMAN
Suffix:III
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:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-0982
Mailing Address - Country:US
Mailing Address - Phone:757-874-5666
Mailing Address - Fax:757-874-8625
Practice Address - Street 1:5701 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2773
Practice Address - Country:US
Practice Address - Phone:757-874-5666
Practice Address - Fax:757-874-8625
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV8805C098Medicare PIN