Organization
P I C INCORPORATED
Active
Other names
Holladay Physical Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE VAN GUNDERSEN DC, FACO (PRESIDENT)
(801) 272-8471
Entity
Organization
Contact information
Practice address
4211 HOLLADAY BLVD, HOLLADAY, UT 84124-2607
(801) 272-8471
Mailing address
4211 HOLLADAY BLVD, HOLLADAY, UT 84124-2607
(801) 272-8471
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
161820-1202
UT
Other
Enumeration date
02/24/2012
Last updated
02/24/2012
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