P I C Incorporated

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

161820-1202 Issued in UT

Legal business name

P I C INCORPORATED

Practice address

4211 Holladay Blvd
Holladay, UT 84124-2607

Phone

(801) 272-8471

NPI assigned

Feb 24, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Van Gundersen, DC, FACONPI 1952409476

Title

President

Phone

(801) 272-8471

Specialties & licenses 1

Addresses

Other names 1

• Holladay Physical Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce Van Gundersen, DC, FACO

  • Orthopedic Chiropractor
  • Salt Lake City, UT
  • NPI 1952409476
  Medicare reassignment Authorized official
• Joshua James Christensen, D.C.

  • Chiropractor
  • Tumwater, WA
  • NPI 1194737072
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1487928222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 HOLLADAY BLVD",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841242607",
            "telephone_number": "801-272-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOLLADAY BLVD",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841242607",
            "telephone_number": "801-272-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P I C INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "GUNDERSEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-272-8471",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC, FACO"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "UT",
            "license": "161820-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holladay Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olympus Spine and Pain
• Oral Design Dental
• Emily Ann Osisek
• Jeffrey Todd Owens, DC
• Michelle Owens, DPT, ATC
• Jeremy Pack
• Palliative Medicine Associates LLC
• Matthew D Pearson, MD
• Alyssa Peiffer
• Adam Phillip Pendleton, M.D.

• Orthopedic Chiropractor in Holladay, UT
• Providers in Holladay, UT by specialty
• Orthopedic Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.