Healthcare Provider Details

I. General information

NPI: 1457415192
Provider Name (Legal Business Name): ERIC D WUNSCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N. PLUMAS STREET
WILLOWS CA
95988
US

IV. Provider business mailing address

414 N. PLUMAS STREET
WILLOWS CA
95988
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-2751
  • Fax:
Mailing address:
  • Phone: 530-934-2751
  • Fax: 530-934-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 0231440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: