Provider Demographics
NPI:1912178724
Name:SUNDBY FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SUNDBY FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SUNDBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-883-4353
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-0158
Mailing Address - Country:US
Mailing Address - Phone:701-883-4353
Mailing Address - Fax:701-883-4228
Practice Address - Street 1:100 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-7311
Practice Address - Country:US
Practice Address - Phone:701-883-4353
Practice Address - Fax:701-883-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty