Provider Demographics
NPI:1457415192
Name:WUNSCH, ERIC D (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:WUNSCH
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 1:414 N. PLUMAS STREET
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988
Mailing Address - Country:US
Mailing Address - Phone:530-934-2751
Mailing Address - Fax:530-934-8625
Practice Address - Street 1:414 N. PLUMAS STREET
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988
Practice Address - Country:US
Practice Address - Phone:530-934-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 0231440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0231440OtherLICENSE NUMBER
CA68-0339635Medicare UPIN