MEDICARE: DR. KEVIN JAMES SUNDBERG D.C.

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	2301010620	MI

General Provider Information

NPI Number	:	1972017481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JAMES SUNDBERG D.C.

Provider Business Mailing Address
First Line	:	2155 84TH ST SW
Second Line	:	STE 4
City	:	BYRON CENTER
State	:	MI
Zip	:	49315-8259
Country	:	US
Telephone Number	:	269-375-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4403 W MICHIGAN AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5866
Country	:	US
Telephone Number	:	269-375-6565
Fax Number	:

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

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	09/15/2020

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