Provider Demographics
NPI:1073831475
Name:LUNDELL, KATY L (DC)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:L
Last Name:LUNDELL
Suffix:
Gender:F
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-0066
Mailing Address - Country:US
Mailing Address - Phone:320-564-1209
Mailing Address - Fax:320-564-1210
Practice Address - Street 1:868 PRENTICE ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1521
Practice Address - Country:US
Practice Address - Phone:320-564-1209
Practice Address - Fax:320-564-1210
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004630Medicare UPIN