Provider Demographics
NPI:1073879466
Name:LUNDSTROM CHIROPRACTIC CENTERS, INC.
Entity Type:Organization
Organization Name:LUNDSTROM CHIROPRACTIC CENTERS, INC.
Other - Org Name:MIDTOWN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-235-1403
Mailing Address - Street 1:111 CENTRAL AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5252
Mailing Address - Country:US
Mailing Address - Phone:507-384-3588
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5252
Practice Address - Country:US
Practice Address - Phone:507-384-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5646261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center