Jacob Michael Sunderlage, DC
Individual provider Active NPI Chiropractor · Fairlawn, VA
NPI 1497422174 · NPPES record last updated Aug 30, 2021
Key facts
- NPI
- 1497422174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 0104-557743 (VA)
- Practice address
- 7350 Peppers Ferry Blvd Ste B
Fairlawn, VA 24141-8999 - Phone
- (540) 731-4357
- NPI assigned
- Aug 30, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240619000820 | MI | Practitioner - Chiropractic | 8729470885 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0104-557743 | VA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eric R Hartman, DC, PLLC | Chiropractor | Current |
Accepting new patients |
| Strength Spine, Sport and Performance PLLC | Chiropractor | Current | Accepting new patients |
| Tuck Clinic of Chiropractic | Chiropractor | Past | Accepting new patients |
| Tuck Chiropractic Corporation | Past |
Accepting new patients |
Locations
302 Baldwin St
Jenison, MI 49428
Phone (616) 457-1168
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 0104-557743 | VA | Yes |
Addresses
Primary practice location
7350 Peppers Ferry Blvd Ste B
Fairlawn, VA 24141-8999
Mailing address
1901 S Main St Ste 5
Blacksburg, VA 24060-6628
Phone (540) 951-6900
Other providers in Fairlawn, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.