Provider Demographics
NPI:1972079085
Name:SUNDBY, DEREK ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALLAN
Last Name:SUNDBY
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 1:808 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2144
Mailing Address - Country:US
Mailing Address - Phone:701-352-0400
Mailing Address - Fax:701-352-0220
Practice Address - Street 1:106 W 2ND AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4117
Practice Address - Country:US
Practice Address - Phone:701-265-4114
Practice Address - Fax:701-265-4113
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6544111N00000X
ND1149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor