Individual
DR. BRUCE VAN GUNDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, FACO
Contact information
Practice address
4211 HOLLADAY BLVD, SALT LAKE CITY, UT 84124-2607
(801) 272-8471
(801) 424-2219
Mailing address
4211 HOLLADAY BLVD, SALT LAKE CITY, UT 84124-2607
(801) 272-8471
(801) 424-2219
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
161820-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161820-1202
STATE LICENSE
UT
05
—
870395551005
—
UT
Enumeration date
09/20/2006
Last updated
07/08/2007
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