Provider Demographics
NPI:1205902715
Name:LEN J BUNDICK, CHIROPRACTOR, P C
Entity type:Organization
Organization Name:LEN J BUNDICK, CHIROPRACTOR, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BUNDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-787-1086
Mailing Address - Street 1:25549 EAST MAIN ST
Mailing Address - Street 2:P O BOX 310
Mailing Address - City:ONLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23418-0310
Mailing Address - Country:US
Mailing Address - Phone:757-787-1086
Mailing Address - Fax:757-787-7953
Practice Address - Street 1:25549 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ONLEY
Practice Address - State:VA
Practice Address - Zip Code:23418-0310
Practice Address - Country:US
Practice Address - Phone:757-787-1086
Practice Address - Fax:757-787-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA381316OtherANTHEM BC BS
VA381316OtherANTHEM BC BS