Jacob Jared Sundberg, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4924 Issued in MN

Practice address

9555 Upland LN N
Maple Grove, MN 55369-4485

Phone

(763) 330-1400

Fax

(529) 977-3172

NPI assigned

Mar 28, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ronald S Mash PA

  • Primary Care Clinic/Center
  • Shakopee, MN
  • NPI 1104952589
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1619096245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485",
            "telephone_number": "763-330-1400",
            "fax_number": "529-977-3172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDBERG",
        "first_name": "JACOB",
        "middle_name": "JARED",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2022-04-25",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.releviumchiro.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9555 Upland Ln N",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553694485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stuck Holdings, Inc.
• Suite Living Senior Care of Maple Grove
• Bryan Daniel Sullivan, D.C.
• Summit Advance Mobile Wound Care LLC
• Summit Orthopedics, LTD
• Sunny Dental P.C.
• Supervalu Pharmacies Inc
• Britta Jessica Svihel, LPC, LADC
• Madalyn Svihel
• Dana M Swanson, PA-C

• Chiropractor in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.