Provider Demographics
NPI:1043436876
Name:LUNDELL, BRANDON M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:M
Last Name:LUNDELL
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 1:619 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4931
Mailing Address - Country:US
Mailing Address - Phone:303-651-1502
Mailing Address - Fax:303-651-9383
Practice Address - Street 1:619 PRATT ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4931
Practice Address - Country:US
Practice Address - Phone:303-651-1502
Practice Address - Fax:303-651-9383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC540758Medicare ID - Type Unspecified
COV00434Medicare UPIN