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General NPI Number Information
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NPI Number | 1972079085
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Entity Type | Individual
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Provider Name | DEREK ALLAN SUNDBY DC
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Gender | Male
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 106 W 2ND AVE S
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City | CAVALIER
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State | ND
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Zip | 58220-4117
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Country | US
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Telephone | 701-265-4114
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Fax | 701-265-4113
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Provider Business Mailing Address
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Address Line | 808 W 12TH ST
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City | GRAFTON
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State | ND
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Zip | 58237-2144
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Country | US
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Telephone | 701-352-0400
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Fax | 701-352-0220
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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 | 6544
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1149
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License Number State | ND
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