Provider Demographics
NPI:1366712739
Name:SUNDBERG, ZACHARY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ROBERT
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4924
Mailing Address - Country:US
Mailing Address - Phone:763-533-0654
Mailing Address - Fax:763-537-5305
Practice Address - Street 1:4221 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4924
Practice Address - Country:US
Practice Address - Phone:763-533-0654
Practice Address - Fax:763-537-5305
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor