Provider Demographics
NPI:1043433063
Name:MILL VALLEY FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:MILL VALLEY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESPER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDBAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-389-9000
Mailing Address - Street 1:591 REDWOOD HWY STE 2300
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-6032
Mailing Address - Country:US
Mailing Address - Phone:415-389-9000
Mailing Address - Fax:415-389-7912
Practice Address - Street 1:591 REDWOOD HWY STE 2300
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-6032
Practice Address - Country:US
Practice Address - Phone:415-389-9000
Practice Address - Fax:415-389-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22400261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service