Provider Demographics
NPI:1093765364
Name:LUNDELL, GAILEN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:GAILEN
Middle Name:ERIC
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 1:3500 HARRISON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2058
Mailing Address - Country:US
Mailing Address - Phone:801-627-2225
Mailing Address - Fax:
Practice Address - Street 1:3500 HARRISON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2058
Practice Address - Country:US
Practice Address - Phone:801-627-2225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT156164-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor