Provider Demographics
NPI:1134308182
Name:MATTHEW J. LUNDEBERG, INC.
Entity Type:Organization
Organization Name:MATTHEW J. LUNDEBERG, INC.
Other - Org Name:LUNDEBERG CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUNDEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-271-1233
Mailing Address - Street 1:5721 DRAGON WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-4518
Mailing Address - Country:US
Mailing Address - Phone:513-271-1233
Mailing Address - Fax:
Practice Address - Street 1:5721 DRAGON WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4518
Practice Address - Country:US
Practice Address - Phone:513-271-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4028591Medicare PIN