Healthcare Provider Details

I. General information

NPI: 1417482084
Provider Name (Legal Business Name): STEVEN S BORDUNOV DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 TAMALPAIS DR
CORTE MADERA CA
94925-1613
US

IV. Provider business mailing address

P.O. BOX 1848
NOVATO CA
94948
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-6500
  • Fax: 415-924-2879
Mailing address:
  • Phone: 415-892-7560
  • Fax: 415-892-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: