Provider Demographics
NPI:1194197368
Name:LUND HEALTH PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LUND HEALTH PROFESSIONAL CORPORATION
Other - Org Name:BLAINE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-703-3509
Mailing Address - Street 1:1630 101ST AVE NE STE 140
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4419
Mailing Address - Country:US
Mailing Address - Phone:763-703-3509
Mailing Address - Fax:763-703-3454
Practice Address - Street 1:1360 101ST AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:763-703-3509
Practice Address - Fax:763-703-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty