Provider Demographics
NPI:1104012467
Name:LUNEBURG, JUSTIN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:LUNEBURG
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 1:11050 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-3740
Mailing Address - Country:US
Mailing Address - Phone:515-777-1014
Mailing Address - Fax:515-777-1015
Practice Address - Street 1:11050 HICKMAN RD STE A
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-3740
Practice Address - Country:US
Practice Address - Phone:563-343-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6125111N00000X
NE1685111N00000X
IA007545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194074971OtherPRACTICE NPI