Healthcare Provider Details

I. General information

NPI: 1336122050
Provider Name (Legal Business Name): JAMES D WUNDERLICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FORT COUCH RD
PITTSBURGH PA
15241-1030
US

IV. Provider business mailing address

219 HORSESHOE CIR
BRIDGEVILLE PA
15017-1109
US

V. Phone/Fax

Practice location:
  • Phone: 412-833-5704
  • Fax: 412-833-3201
Mailing address:
  • Phone: 412-833-5704
  • Fax: 412-833-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007594L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: