Provider Demographics
NPI:1225171820
Name:LUNZER, NANCY (DC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LUNZER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ENTERPRISE AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6814
Mailing Address - Country:US
Mailing Address - Phone:763-552-6161
Mailing Address - Fax:763-237-3254
Practice Address - Street 1:4 ENTERPRISE AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6814
Practice Address - Country:US
Practice Address - Phone:763-552-6161
Practice Address - Fax:763-237-3254
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN850827500Medicaid
MNCO2846Medicare ID - Type Unspecified
MN850827500Medicaid