1205902715 NPI number — LEN J BUNDICK, CHIROPRACTOR, P C

Table of content: (NPI 1205902715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205902715 NPI number — LEN J BUNDICK, CHIROPRACTOR, P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEN J BUNDICK, CHIROPRACTOR, P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205902715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25549 EAST MAIN ST
Provider Second Line Business Mailing Address:
P O BOX 310
Provider Business Mailing Address City Name:
ONLEY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23418-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-787-1086
Provider Business Mailing Address Fax Number:
757-787-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25549 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONLEY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23418-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-787-1086
Provider Business Practice Location Address Fax Number:
757-787-7953
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUNDICK
Authorized Official First Name:
LEN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-787-1086

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104000543 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 381316 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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