Healthcare Provider Details

I. General information

NPI: 1952950172
Provider Name (Legal Business Name): WUNNENBERG ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BENTON RD
BOSSIER CITY LA
71111-3603
US

IV. Provider business mailing address

925 BENTON RD
BOSSIER CITY LA
71111-3603
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-4433
  • Fax: 318-747-4454
Mailing address:
  • Phone: 318-747-4433
  • Fax: 318-747-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN KYLE WUNNENBERG
Title or Position: CEO
Credential: DC
Phone: 805-610-3996