Healthcare Provider Details

I. General information

NPI: 1750505269
Provider Name (Legal Business Name): WUNDERLICH CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 LAFAYETTE ST
CAPE CORAL FL
33904-9763
US

IV. Provider business mailing address

1402 LAFAYETTE ST
CAPE CORAL FL
33904-9763
US

V. Phone/Fax

Practice location:
  • Phone: 239-540-9888
  • Fax: 239-540-9889
Mailing address:
  • Phone: 239-540-9888
  • Fax: 239-540-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 7090
License Number StateFL

VIII. Authorized Official

Name: CHANCE ALAN WUNDERLICH
Title or Position: OWNER CHIROPRACTOR
Credential: D.C.
Phone: 239-540-9888