Bruce Van Gundersen, DC, FACO

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

161820-1202 Issued in UT

Practice address

4211 Holladay Blvd
Salt Lake City, UT 84124-2607

Phone

(801) 272-8471

Fax

(801) 424-2219

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• P I C Incorporated

  dba Holladay Physical Medicine

  • Orthopedic Chiropractor
  • Holladay, UT
  • NPI 1487928222
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952409476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 HOLLADAY BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242607",
            "telephone_number": "801-272-8471",
            "fax_number": "801-424-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOLLADAY BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242607",
            "telephone_number": "801-272-8471",
            "fax_number": "801-424-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDERSEN",
        "first_name": "BRUCE",
        "middle_name": "VAN",
        "name_prefix": "Dr.",
        "credential": "DC, FACO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "UT",
            "license": "161820-1202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870395551005",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "161820-1202",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Gullberg, MFT, RN
• Kaitlin Gulley
• Mary Gully
• Matthew Gumbleton, M.D., PH.D.
• Alistair Gummow, MB BCHIR FRCR
• Marc B Gunderson, LCSW
• Gregory Scott Gunn
• Katherine Brooke Gunn
• Melissa Rae Gunner, DPT
• Sadie Elise Gunnerson

• Orthopedic Chiropractor in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Orthopedic Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.