Provider Demographics
NPI:1518143981
Name:LUNDEEN, ALAN RUSS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RUSS
Last Name:LUNDEEN
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 1:201 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2327
Mailing Address - Country:US
Mailing Address - Phone:602-503-1424
Mailing Address - Fax:602-532-9516
Practice Address - Street 1:201 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2327
Practice Address - Country:US
Practice Address - Phone:602-503-1424
Practice Address - Fax:602-532-9516
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1134201668OtherGROUP NPI
AZZ85232Medicare PIN