Provider Demographics
NPI:1891365383
Name:GUNDERSON CHIROPRACTIC
Entity Type:Organization
Organization Name:GUNDERSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-851-1520
Mailing Address - Street 1:1975 ZINFANDEL DR STE B
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2880
Mailing Address - Country:US
Mailing Address - Phone:916-851-1520
Mailing Address - Fax:
Practice Address - Street 1:1975 ZINFANDEL DR STE B
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2880
Practice Address - Country:US
Practice Address - Phone:916-851-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty