Provider Demographics
NPI:1275594350
Name:LUNDEBERG, MATTHEW J (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:LUNDEBERG
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 1:5721 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:513-271-4237
Practice Address - Street 1:6678 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-9503
Practice Address - Country:US
Practice Address - Phone:614-660-5560
Practice Address - Fax:614-633-1134
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2186638Medicaid
OH000000123010OtherANTHEM BC/BS
OHP00126671OtherRAILROAD MEDICARE
OH2534578OtherAETNA
OH3069C-05OtherHUMANA
OH311727481026OtherCARESOURCE
OH2534578OtherAETNA