NPIMap

Organization Active NPI

Sundberg Chiropractic, P.a.

  • Chiropractor
  • Plymouth, MN
National Provider Identifier
1720267669
Registry record updated Oct 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4924 Issued in MN
Legal business name
SUNDBERG CHIROPRACTIC, P.A.
Practice address
14332 21St Ave N
Suite 100
Plymouth, MN 55447-4631
Phone
(612) 325-0308
Fax
(763) 426-4252
NPI assigned
Oct 28, 2007
Last updated
Oct 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2007

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

Authorized official

Name
Dr. Jacob Jared Sundberg, D.C.
Title
President
Phone
(612) 325-0308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4924 MN Primary

Addresses

Primary practice location

14332 21St Ave N
Suite 100
Plymouth, MN 55447-4631

Mailing address

8645 2ND Ave S
Bloomington, MN 55420-2924
Phone (612) 325-0308

National Provider Directory

National Provider Directory

Locations

14332 21st Ave N
Ste 100
Plymouth, MN 55447
Phone (612) 325-0308

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1193529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193529600000",
    "number": "1720267669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8645 2ND AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554202924",
            "telephone_number": "612-325-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14332 21ST AVE N",
            "address_2": "SUITE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474631",
            "telephone_number": "612-325-0308",
            "fax_number": "763-426-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDBERG CHIROPRACTIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-28",
        "last_updated": "2007-10-28",
        "status": "A",
        "authorized_official_last_name": "SUNDBERG",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "JARED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-325-0308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2007; 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.