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General NPI Number Information
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NPI Number | 1104883164
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES MUNDERLOH DC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1500 E CEDAR AVE STE 80
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-556-0707
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Fax | 928-522-8462
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Provider Business Mailing Address
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Address Line | 1500 E CEDAR AVE STE 80
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-556-0707
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Fax | 928-522-8462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5935
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 1058
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License Number State | AZ
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