Provider Demographics
NPI:1356534630
Name:FUNDERBURK, URSULA D (DC)
Entity type:Individual
Prefix:DR
First Name:URSULA
Middle Name:D
Last Name:FUNDERBURK
Suffix:
Gender:F
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:PO BOX 31473
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77231-1473
Mailing Address - Country:US
Mailing Address - Phone:832-282-0458
Mailing Address - Fax:713-665-9677
Practice Address - Street 1:6550 MAPLERIDGE ST STE 222
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4647
Practice Address - Country:US
Practice Address - Phone:713-665-9675
Practice Address - Fax:713-665-9677
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6673111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU62564Medicare UPIN