Provider Demographics
NPI:1992117543
Name:GUNDLACH, MARK ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:GUNDLACH
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 1:480 N FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2326
Mailing Address - Country:US
Mailing Address - Phone:785-443-3621
Mailing Address - Fax:
Practice Address - Street 1:480 N FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701
Practice Address - Country:US
Practice Address - Phone:785-443-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor