MEDICARE: JAMES D WUNDERLICH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC007594L	PA

General Provider Information

NPI Number	:	1336122050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D WUNDERLICH D.C.

Provider Business Mailing Address
First Line	:	219 HORSESHOE CIR
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1109
Country	:	US
Telephone Number	:	412-833-5704
Fax Number	:	412-833-3201

Provider Business Practice Location Address
First Line	:	110 FORT COUCH RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1030
Country	:	US
Telephone Number	:	412-833-5704
Fax Number	:	412-833-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/08/2007

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