Provider Demographics
NPI:1336245554
Name:GUNDLACH, CARY L (DC)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:L
Last Name:GUNDLACH
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 1:3530 S VAL VISTA DR
Mailing Address - Street 2:STE A111
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7319
Mailing Address - Country:US
Mailing Address - Phone:480-878-5480
Mailing Address - Fax:480-696-3807
Practice Address - Street 1:3530 S VAL VISTA DR
Practice Address - Street 2:STE A111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7319
Practice Address - Country:US
Practice Address - Phone:480-878-5480
Practice Address - Fax:480-696-3807
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8053111N00000X
WI3575-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38910600Medicaid
WI000370880Medicare ID - Type Unspecified
WI38910600Medicaid