Provider Demographics
NPI:1508460627
Name:LUNDGREN, AUSTIN GREG (DC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GREG
Last Name:LUNDGREN
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 1:5821 PLAZA PASEO ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4808
Mailing Address - Country:US
Mailing Address - Phone:505-917-3677
Mailing Address - Fax:
Practice Address - Street 1:2003 SOUTHERN BLVD SE
Practice Address - Street 2:#109
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-8712
Practice Address - Country:US
Practice Address - Phone:505-892-2222
Practice Address - Fax:505-892-1056
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor