Provider Demographics
NPI:1003987876
Name:LUNDGREN, ERICK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:JAMES
Last Name:LUNDGREN
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 1:4600 LAKE ROAD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1845
Mailing Address - Country:US
Mailing Address - Phone:763-588-7099
Mailing Address - Fax:
Practice Address - Street 1:4600 LAKE ROAD AVE STE 301
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-588-7099
Practice Address - Fax:763-522-2222
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC07J2LIOtherBLUE CROSS BLUE SJIELD
MNC07J2LIOtherBLUE CROSS BLUE SJIELD