Organization
PROFORMA HEALTH PLLC
Active
Parent organization
MUNDERLOH HOLDINGS LLC
Other names
MUNDERLOH CHIROPRACTIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MUNDERLOH HOLDINGS LLC
Authorized official
DR. TIMOTHY JAMES MUNDERLOH D.C. (PRESIDENT)
(928) 556-0707
Entity
Organization
Contact information
Practice address
1501 S YALE ST, SUITE 250, FLAGSTAFF, AZ 86001-7304
(928) 556-0707
(928) 779-2223
Mailing address
1501 S YALE ST, SUITE 250, FLAGSTAFF, AZ 86001-7304
(928) 556-0707
(928) 779-2223
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
111NN0400X
Neurology Chiropractor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104883164
PROVIDER NPI
AZ
01
—
5935
CHIROPRACTIC LICENSE
AZ
Enumeration date
07/19/2012
Last updated
07/19/2012
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