Provider Demographics
NPI:1477740819
Name:LUNDQUIST CHIROPRACTIC
Entity Type:Organization
Organization Name:LUNDQUIST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:863-293-8686
Mailing Address - Street 1:601 AVENUE B NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4656
Mailing Address - Country:US
Mailing Address - Phone:863-293-8686
Mailing Address - Fax:863-299-1764
Practice Address - Street 1:601 AVENUE B NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4656
Practice Address - Country:US
Practice Address - Phone:863-293-8686
Practice Address - Fax:863-299-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5458Medicare PIN