Provider Demographics
NPI:1871649509
Name:GUNDERSON, TIMOTHY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:GUNDERSON
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 1:2204 N HILLCREST PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2626
Mailing Address - Country:US
Mailing Address - Phone:715-598-4954
Mailing Address - Fax:
Practice Address - Street 1:2204 N HILLCREST PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2626
Practice Address - Country:US
Practice Address - Phone:715-598-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4285-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor