MEDICARE: DR. SEAN NIKOLAS WUNDERLE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	DC-04896	OH

General Provider Information

NPI Number	:	1326685611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN NIKOLAS WUNDERLE DC

Provider Business Mailing Address
First Line	:	1930 PEARL RD UNIT B
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-558-1119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 PEARL RD UNIT B
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-558-1119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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Directions to “ DR. SEAN NIKOLAS WUNDERLE DC” Practice Location

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