MEDICARE: WUNDERLICH CHIROPRACTIC CLINIC PA

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	111N00000X	Chiropractor	CH 7090	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AB985	OTHER	FL	MEDICARE DOC PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55461	OTHER	FL	BCBS ID#
3	CH7090	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1750505269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WUNDERLICH CHIROPRACTIC CLINIC PA

Provider Business Mailing Address
First Line	:	1402 LAFAYETTE ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9763
Country	:	US
Telephone Number	:	239-540-9888
Fax Number	:	239-540-9889

Provider Business Practice Location Address
First Line	:	1402 LAFAYETTE ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9763
Country	:	US
Telephone Number	:	239-540-9888
Fax Number	:	239-540-9889

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	CHANCE ALAN WUNDERLICH
Credential	:	D.C.
Telephone Number	:	239-540-9888

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	01/22/2008

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Directions to “WUNDERLICH CHIROPRACTIC CLINIC PA ” Practice Location

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