Provider Demographics
NPI:1114115532
Name:LUNDSTROM CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LUNDSTROM CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-388-3811
Mailing Address - Street 1:902 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3543
Mailing Address - Country:US
Mailing Address - Phone:605-388-3811
Mailing Address - Fax:605-388-3812
Practice Address - Street 1:902 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3543
Practice Address - Country:US
Practice Address - Phone:605-388-3811
Practice Address - Fax:605-388-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S7665Medicare PIN