Provider Demographics
NPI:1245310085
Name:SUNDBERG, ADAM PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAUL
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 RICHARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2979
Mailing Address - Country:US
Mailing Address - Phone:218-340-6110
Mailing Address - Fax:
Practice Address - Street 1:4135 RICHARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2979
Practice Address - Country:US
Practice Address - Phone:218-340-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN77G40SUOtherBLUE CROSS BLUE SHIELD
MN621906300Medicaid
MN693252OtherCHIROPRACTIC CARE OF MN
MN44-02858OtherMEDICA
MN350003539Medicare ID - Type Unspecified
MN77G40SUOtherBLUE CROSS BLUE SHIELD