Provider Demographics
NPI:1952950172
Name:WUNNENBERG ENTERPRISES LLC
Entity Type:Organization
Organization Name:WUNNENBERG ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:WUNNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-610-3996
Mailing Address - Street 1:925 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3603
Mailing Address - Country:US
Mailing Address - Phone:318-747-4433
Mailing Address - Fax:318-747-4454
Practice Address - Street 1:925 BENTON RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3603
Practice Address - Country:US
Practice Address - Phone:318-747-4433
Practice Address - Fax:318-747-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty