Healthcare Provider Details

I. General information

NPI: 1063090397
Provider Name (Legal Business Name): ASHLEY ELIZABETH WUNDERLE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N HEATHER HILL DR
BELLEFONTAINE OH
43311-2701
US

IV. Provider business mailing address

119 N HEATHER HILL DR
BELLEFONTAINE OH
43311-2701
US

V. Phone/Fax

Practice location:
  • Phone: 419-967-4321
  • Fax:
Mailing address:
  • Phone: 419-967-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC-05065
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberDC-05065
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC-05065
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC-05065
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC-05065
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC-05065
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-05065
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License NumberDC-05065
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC-05065
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC-05065
License Number StateOH
# 11
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: