Provider Demographics
NPI:1417499567
Name:LUND, DEREK
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:LUND
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:J
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:522 HEWETT ST
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1926
Mailing Address - Country:US
Mailing Address - Phone:715-743-3600
Mailing Address - Fax:
Practice Address - Street 1:522 HEWETT ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1926
Practice Address - Country:US
Practice Address - Phone:715-743-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5220-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor