Jacob B Gunderson, DC, ATC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7215 Issued in MN

Practice address

19260 Evans St NW
Elk River, MN 55330-1076

Phone

(763) 441-7788

NPI assigned

Jan 3, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bodywise Chiropractic CenterGroup PAC ID 2264456433, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bodywise Chiropractic Center

  • Chiropractor
  • Elk River, MN
  • NPI 1699809756
  Medicare reassignment Care Compare group NPD
• Gustavus Adolphus College

  • Family Nurse Practitioner
  • Saint Peter, MN
  • NPI 1508911330
  NPD (past)

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1780157669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19260 EVANS ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301076",
            "telephone_number": "763-441-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 EVANS ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301076",
            "telephone_number": "763-441-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDERSON",
        "first_name": "JACOB",
        "middle_name": "B",
        "credential": "DC, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-03",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "7215",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Group Health, Inc.
• Kefeng Gu, M.D.
• Guardian Angels Elim Home Care, Inc
• Guardian Angels Elim Home Care, Inc
• Guardian Angels Health Services, Inc.
• Taylor Gustafson
• Brittany Irene Guthridge
• Thomas J Guyn, M.D.
• Marc H Haaland, LPC
• Rebecca Haas

• Chiropractor in Elk River, MN
• Providers in Elk River, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.