Healthcare Provider Details

I. General information

NPI: 1992991749
Provider Name (Legal Business Name): WUNDER CHIROPRACTIC LIFE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MAIN ST
FLEMINGTON NJ
08822-1468
US

IV. Provider business mailing address

8 MAIN ST
FLEMINGTON NJ
08822-1468
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-1714
  • Fax: 908-788-0885
Mailing address:
  • Phone: 908-788-1714
  • Fax: 908-788-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00477300
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID J. WUNDER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 908-265-2346