Healthcare Provider Details

I. General information

NPI: 1205902715
Provider Name (Legal Business Name): LEN J BUNDICK, CHIROPRACTOR, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25549 EAST MAIN ST.
ONLEY VA
23418-0310
US

IV. Provider business mailing address

25549 EAST MAIN ST P O BOX 310
ONLEY VA
23418-0310
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-1086
  • Fax: 757-787-7953
Mailing address:
  • Phone: 757-787-1086
  • Fax: 757-787-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000543
License Number StateVA

VIII. Authorized Official

Name: DR. LEN JOSEPH BUNDICK
Title or Position: OWNER
Credential: D.C.
Phone: 757-787-1086