Provider Demographics
NPI:1316106552
Name:SUNDERLAND CHIROPRACTIC L.L.C
Entity type:Organization
Organization Name:SUNDERLAND CHIROPRACTIC L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SUNDERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-371-9979
Mailing Address - Street 1:100 ANGELA LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3769
Mailing Address - Country:US
Mailing Address - Phone:318-371-9979
Mailing Address - Fax:318-371-9949
Practice Address - Street 1:100 ANGELA LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3769
Practice Address - Country:US
Practice Address - Phone:318-371-9979
Practice Address - Fax:318-371-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty